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Karimi-Shahrbabak E, Di Chiara C, Farrar DS, Abu Fadaleh SM, Peresin J, Low B, Avelar-Rodriguez D, Orkin J, Science M, Piché-Renaud PP, Morris SK. COVID-19 vaccine acceptance and uptake among caregivers of children aged 5-11 years in Ontario, Canada: A cross-sectional survey. Vaccine 2024:S0264-410X(24)00553-X. [PMID: 38772834 DOI: 10.1016/j.vaccine.2024.05.007] [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: 10/24/2023] [Revised: 04/25/2024] [Accepted: 05/09/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Although COVID-19 vaccine safety in 5-11-year-old children has been documented, half of Ontarian children this age remain unvaccinated. This study aimed to assess caregivers' vaccine acceptance for 5-11-year-old children and identify factors associated with vaccine non-acceptance. METHODS A multi-language self-administered survey was sent to caregivers of 5-11-year-old children through schools and community health centers within the Greater Toronto Area from April-July 2022. Sociodemographic characteristics and immunization behaviours were collected for caregivers, their 5-11-year-old children, and any older siblings. The primary outcome, COVID-19 vaccine acceptance, was previous uptake of COVID-19 vaccine or caregiver intent to vaccinate for their 5-11-year-old child. Data were analyzed using descriptive statistics and multivariable logistic regression. RESULTS In total, 807 caregivers were included in analysis. Although 93 % of caregivers had received two doses of COVID-19 vaccine, 77 % had a 5-11-year-old child who received at least one dose of vaccine. Caregivers age was associated with vaccine acceptance (vs. < 40 years; adjusted odds ratio [aOR] 2.1, 95 % confidence interval [CI] 1.4-3.1 for ages 40-49; aOR 2.8, 95 % CI 1.1-7.1 for ages ≥50 years). Immunization factors associated with vaccine acceptance included caregiver COVID-19 vaccination (aOR 38.1 vs. unvaccinated caregivers; 95 % CI 15.8-92.3), older siblings COVID-19 vaccination (aOR 49.2 vs. unvaccinated siblings; 95 % CI 18.3-132.3), and recent influenza vaccination for the child (aOR 6.9 vs. no influenza vaccine; 95 % CI 4.6-10.5). Among 189 caregivers with unvaccinated 5-11-year-old children, the most common reasons for non-acceptance were concerns about long-term side effects (59 %), lack of experience vaccinating children (41 %), and concerns that vaccines were developed too quickly (39 %). CONCLUSION Acceptance of COVID-19 vaccination for 5-11-year-old children were associated with caregiver vaccine behaviors and sociodemographic factors. These findings highlight groups of caregivers that can be targeted for educational interventions and concerns that may be addressed to increase vaccine confidence.
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Affiliation(s)
- Elahe Karimi-Shahrbabak
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Costanza Di Chiara
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada; Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8, Canada.
| | - Daniel S Farrar
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Sarah M Abu Fadaleh
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Joelle Peresin
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - Brooke Low
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada.
| | - David Avelar-Rodriguez
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON M5G 1X8, Canada.
| | - Julia Orkin
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON M5G 1X8, Canada.
| | - Michelle Science
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON M5G 1X8, Canada.
| | - Pierre-Philippe Piché-Renaud
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON M5G 1X8, Canada.
| | - Shaun K Morris
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada; Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON M5G 1X8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada; Division of Clinical Public Health and Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, 155 College Street, Toronto, ON M5T 3M7, Canada.
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Modler J, Morris SK, Bettinger JA, Bancej C, Burton C, Foo C, Halperin SA, Jadavji T, Kazmi K, Sadarangani M, Schober T, Papenburg J. Bloodstream Infections in Children Hospitalized for Influenza, the Canadian Immunization Monitoring Program Active. Pediatr Infect Dis J 2024; 43:301-306. [PMID: 38048641 DOI: 10.1097/inf.0000000000004199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND We aimed to estimate the proportion of children hospitalized for influenza whose illness was complicated by bloodstream infection, describe their clinical course, and identify the factors associated with bloodstream infection. METHODS We performed active surveillance for laboratory-confirmed influenza hospitalizations among children ≤16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, from the 2010-2011 to 2020-2021 influenza seasons. Factors associated with bloodstream infection were identified using multivariable logistic regression analyses. RESULTS Among 9179 laboratory-confirmed influenza hospital admissions, bloodstream infection occurred in 87 children (0.9%). Streptococcus pyogenes (22%), Staphylococcus aureus (18%) and Streptococcus pneumoniae (17%) were the most common bloodstream infection pathogens identified. Children with cancer [adjusted odds ratio (aOR): 2.78; 95% confidence interval (CI): 1.23-5.63], a laboratory-confirmed nonbloodstream bacterial infection (aOR: 14.1; 95% CI: 8.04-24.3) or radiographically-confirmed pneumonia (aOR: 1.87; 95% CI: 1.17-2.97) were more likely to experience a bloodstream infection, whereas children with chronic lung disorders were less likely (aOR: 0.41; 95% CI: 0.19-0.80). Disease severity markers such as intensive care unit admission (aOR: 2.11; 95% CI: 1.27-3.46), mechanical ventilation (aOR: 2.84; 95% CI: 1.63-4.80) and longer hospital length of stay (aOR: 1.02; 95% CI: 1.01-1.03) were associated with bloodstream infection. Bloodstream infection also increased the odds of death (aOR: 13.0; 95% CI: 4.84-29.1) after adjustment for age, influenza virus type and the presence of any at-risk chronic condition. CONCLUSIONS Bloodstream infections, although infrequent, are associated with intensive care unit admission, mechanical ventilation, increased hospital length of stay and in-hospital mortality, thus requiring increased levels of care among pediatric influenza hospitalizations.
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Affiliation(s)
- Jacqueline Modler
- From the Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Quebec, Canada
| | - Shaun K Morris
- Division of Pediatric Infectious Diseases, The Hospital for Sick Children, and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christina Bancej
- Center for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Catherine Burton
- Division of Pediatric Infectious Diseases, Department of Paediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl Foo
- Pediatric Infectious Diseases, Janeway Children's Health and Rehabilitation Centre, Eastern Health Regional Authority, St. John's, Newfoundland and Labrador, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Taj Jadavji
- Section of Infectious Diseases, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Kescha Kazmi
- Division of Pediatric Infectious Diseases, The Hospital for Sick Children, and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tilmann Schober
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Quebec, Canada
| | - Jesse Papenburg
- From the Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Quebec, Canada
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, Quebec, Canada
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Fung A, Loutet M, Roth DE, Wong E, Gill PJ, Morris SK, Beyene J. Clinical prediction models in children that use repeated measurements with time-varying covariates: a scoping review. Acad Pediatr 2024:S1876-2859(24)00115-3. [PMID: 38561061 DOI: 10.1016/j.acap.2024.03.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/29/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Emerging evidence suggests that clinical prediction models that use repeated (time-varying) measurements within each patient may have higher predictive accuracy than models that use patient information from a single measurement. OBJECTIVE To determine the breadth of the published literature reporting the development of clinical prediction models in children that use time-varying predictors. DATA SOURCES MEDLINE, EMBASE and Cochrane databases. ELIGIBILITY CRITERIA We included studies reporting the development of a multivariable clinical prediction model in children, with or without validation, to predict a repeatedly measured binary or time-to-event outcome and utilizing at least one repeatedly measured predictor. SYNTHESIS METHODS We categorized included studies by the method used to model time-varying predictors. RESULTS Of 99 clinical prediction model studies that had a repeated measurements data structure, only 27 (27%) used methods that incorporated the repeated measurements as time-varying predictors in a single model. Among these 27 time-varying prediction model studies, we grouped model types into nine categories: time-dependent Cox regression, generalized estimating equations, random effects model, landmark model, joint model, neural network, K-nearest neighbor, support vector machine and tree-based algorithms. Where there was comparison of time-varying models to single measurement models, using time-varying predictors improved predictive accuracy. CONCLUSIONS Various methods have been used to develop time-varying prediction models in children, but there is a paucity of pediatric time-varying models in the literature. Incorporating time-varying covariates in pediatric prediction models may improve predictive accuracy. Future research in pediatric prediction model development should further investigate whether incorporation of time-varying covariates improves predictive accuracy.
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Affiliation(s)
- Alastair Fung
- Division of Paediatric Medicine (A Fung, DE Roth, and PJ Gill), Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health (A Fung, M Loutet, DE Roth, PJ Gill, SK Morris, and J Beyene), University of Toronto, Toronto, Ontario, Canada; Centre for Global Child Health (A Fung, M Loutet, DE Roth, and SK Morris), Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Miranda Loutet
- Dalla Lana School of Public Health (A Fung, M Loutet, DE Roth, PJ Gill, SK Morris, and J Beyene), University of Toronto, Toronto, Ontario, Canada; Centre for Global Child Health (A Fung, M Loutet, DE Roth, and SK Morris), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel E Roth
- Division of Paediatric Medicine (A Fung, DE Roth, and PJ Gill), Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health (A Fung, M Loutet, DE Roth, PJ Gill, SK Morris, and J Beyene), University of Toronto, Toronto, Ontario, Canada; Centre for Global Child Health (A Fung, M Loutet, DE Roth, and SK Morris), Hospital for Sick Children, Toronto, Ontario, Canada; Temerty Faculty of Medicine (DE Roth, E Wong, PJ Gill, and SK Morris), University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences (DE Roth, PJ Gill, and SK Morris), Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Elliott Wong
- Temerty Faculty of Medicine (DE Roth, E Wong, PJ Gill, and SK Morris), University of Toronto, Toronto, Ontario, Canada
| | - Peter J Gill
- Division of Paediatric Medicine (A Fung, DE Roth, and PJ Gill), Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health (A Fung, M Loutet, DE Roth, PJ Gill, SK Morris, and J Beyene), University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine (DE Roth, E Wong, PJ Gill, and SK Morris), University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences (DE Roth, PJ Gill, and SK Morris), Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Shaun K Morris
- Dalla Lana School of Public Health (A Fung, M Loutet, DE Roth, PJ Gill, SK Morris, and J Beyene), University of Toronto, Toronto, Ontario, Canada; Centre for Global Child Health (A Fung, M Loutet, DE Roth, and SK Morris), Hospital for Sick Children, Toronto, Ontario, Canada; Temerty Faculty of Medicine (DE Roth, E Wong, PJ Gill, and SK Morris), University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences (DE Roth, PJ Gill, and SK Morris), Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Division of Infectious Diseases (SK Morris), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph Beyene
- Dalla Lana School of Public Health (A Fung, M Loutet, DE Roth, PJ Gill, SK Morris, and J Beyene), University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence and Impact (J Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Farrar DS, Pell LG, Muhammad Y, Khan SH, Tanner Z, Bassani DG, Ahmed I, Karim M, Madhani F, Paracha S, Khan MA, Soofi SB, Taljaard M, Spitzer RF, Abu Fadaleh SM, Bhutta ZA, Morris SK. Association of maternal, obstetric, fetal, and neonatal mortality outcomes with Lady Health Worker coverage from a cross-sectional survey of >10,000 households in Gilgit-Baltistan, Pakistan. PLOS Glob Public Health 2024; 4:e0002693. [PMID: 38412169 PMCID: PMC10898742 DOI: 10.1371/journal.pgph.0002693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
Pakistan has among the highest rates of maternal, perinatal, and neonatal mortality globally. Many of these deaths are potentially preventable with low-cost, scalable interventions delivered through community-based health worker programs to the most remote communities. We conducted a cross-sectional survey of 10,264 households during the baseline phase of a cluster randomized controlled trial (cRCT) in Gilgit-Baltistan, Pakistan from June-August 2021. The survey was conducted through a stratified, two-stage sampling design with the objective of estimating the neonatal mortality rate (NMR) within the study catchment area, and informing implementation of the cRCT. Study outcomes were self-reported and included neonatal death, stillbirth, health facility delivery, maternal death, postpartum hemorrhage (PPH), and Lady Health Worker (LHW) coverage. Summary statistics (proportions and rates) were weighted according to the sampling design, and mixed-effects Poisson regression was conducted to explore the relationship between LHW coverage and maternal/newborn outcomes. We identified 7,600 women who gave birth in the past five years, among whom 13% reported experiencing PPH. The maternal mortality ratio was 225 maternal deaths per 100,000 live births (95% confidence interval [CI] 137-369). Among 12,376 total births, the stillbirth rate was 41.4 per 1,000 births (95% CI 36.8-46.7) and the perinatal mortality rate was 53.0 per 1,000 births (95% CI 47.6-59.0). Among 11,863 live births, NMR was 16.2 per 1,000 live births (95% CI 13.6-19.3) and 65% were delivered at a health facility. LHW home visits were associated with declines in PPH (risk ratio [RR] 0.89 per each additional visit, 95% CI 0.83-0.96) and late neonatal mortality (RR 0.80, 95% CI 0.67-0.97). Intracluster correlation coefficients were also estimated to inform the planning of future trials. The high rates of maternal, perinatal, and neonatal death in Gilgit-Baltistan continue to fall behind targets of the 2030 Sustainable Development Goals.
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Affiliation(s)
- Daniel S Farrar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa G Pell
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yasin Muhammad
- Gilgit Regional Office, Aga Khan Health Service-Pakistan, Gilgit-Baltistan, Pakistan
| | - Sher Hafiz Khan
- Gilgit Regional Office, Aga Khan Health Service-Pakistan, Gilgit-Baltistan, Pakistan
| | - Zachary Tanner
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Imran Ahmed
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Muhammad Karim
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Falak Madhani
- Aga Khan Health Service-Pakistan, Karachi, Sindh, Pakistan
- Brain and Mind Institute, Aga Khan University, Karachi, Sindh, Pakistan
| | - Shariq Paracha
- Aga Khan Health Service-Pakistan, Karachi, Sindh, Pakistan
| | - Masood Ali Khan
- Gilgit Regional Office, Aga Khan Health Service-Pakistan, Gilgit-Baltistan, Pakistan
| | - Sajid B Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Rachel F Spitzer
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Section of Gynecology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah M Abu Fadaleh
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
- Institute for Global Health & Development, The Aga Khan University, South-Central Asia & East Africa, Karachi, Pakistan
| | - Shaun K Morris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
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Ali M, El Hafid M, Farrar DS, Kourdi H, Rea E, Waters V, Lam R, Morris SK, Kitai I. Travel-acquired paediatric tuberculosis in the Greater Toronto Area, Canada, 2002-2018. Eur Respir J 2024; 63:2301533. [PMID: 38212078 DOI: 10.1183/13993003.01533-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Affiliation(s)
- Mohsin Ali
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
- These authors contributed equally to this work
| | - Melanie El Hafid
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
- These authors contributed equally to this work
| | - Daniel S Farrar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Haifa Kourdi
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Rea
- Tuberculosis Program, Toronto Public Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Valerie Waters
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ray Lam
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ian Kitai
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Kazmi K, Krueger C, Wong W, Baertschiger RM, Hui C, Nagy A, Navarro OM, Razik F, Schwartz KL, Boggild AK, Morris SK. A Canadian children's hospital's experience with cystic echinococcosis over 30 years: A case series. J Assoc Med Microbiol Infect Dis Can 2024; 8:262-271. [PMID: 38250618 PMCID: PMC10797762 DOI: 10.3138/jammi-2022-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/03/2023] [Accepted: 08/19/2023] [Indexed: 01/23/2024]
Abstract
Background Cystic echinococcosis (CE) or hydatid disease caused by the cestode Echinococcus granulosus sensu lato is an uncommon infection in Canada especially among children. There are limited reports describing the clinical presentation and management in Canadian children. Methods The medical records of all children diagnosed with CE at a quaternary paediatric centre in Ontario between January 1988 and August 2021 were retrospectively reviewed. The clinical course, management, and outcomes of each case were summarized. Results We report two paediatric cases of cystic echinococcosis (CE) in detail and review four additional cases seen at our institution over 33.5 years. The first case was a previously healthy 12-year-old boy with pulmonary CE resulting in unilateral lung collapse and mediastinal shift, who was presumedly infected while living in the Middle East. The second case was a previously healthy 3-year-old girl with pulmonary CE acquired locally in southern Ontario. Four other cases of CE with hepatic involvement (median age 12.5 years) were identified during the study period. Five out of six patients received both surgical and medical therapy. Conclusion CE is a rare but serious disease seen in southern Canada that has historically been associated with travel or migration. Due to changes in urban wildlife landscapes and increased global migration, CE may become more prevalent in Canadian children. We describe the first locally acquired case in rural southern Ontario diagnosed at our centre. Prompt recognition of this infection in children by health care providers is important to prevent morbidity and mortality.
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Affiliation(s)
- Kescha Kazmi
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carsten Krueger
- Division of Infectious Diseases, Immunology, and Allergy, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Waison Wong
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Charles Hui
- Division of Infectious Diseases, Immunology, and Allergy, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Anita Nagy
- Division of Pathology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada
| | - Oscar M Navarro
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Fathima Razik
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea K Boggild
- Tropical Disease Unit, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre of Global Child Health, Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Yea C, Barton M, Bitnun A, Morris SK, El Tal T, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Hernandez-de Mezerville M, Gill P, Nateghian A, Aski BH, Manafi AA, Dwilow R, Bullard J, Papenburg J, Scuccimarri R, Lefebvre MA, Cooke S, Dewan T, Restivo L, Lopez A, Sadarangani M, Roberts A, Wong J, Saux NL, Bowes J, Purewal R, Lautermilch J, Foo C, Merckx J, Robinson J, Yeh EA. Neurological involvement in hospitalized children with SARS-CoV-2 infection: a multinational study. Can J Neurol Sci 2024; 51:40-49. [PMID: 36597285 PMCID: PMC9947047 DOI: 10.1017/cjn.2022.347] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Neurological involvement associated with SARS-CoV-2 infection is increasingly recognized. However, the specific characteristics and prevalence in pediatric patients remain unclear. The objective of this study was to describe the neurological involvement in a multinational cohort of hospitalized pediatric patients with SARS-CoV-2. METHODS This was a multicenter observational study of children <18 years of age with confirmed SARS-CoV-2 infection or multisystemic inflammatory syndrome (MIS-C) and laboratory evidence of SARS-CoV-2 infection in children, admitted to 15 tertiary hospitals/healthcare centers in Canada, Costa Rica, and Iran February 2020-May 2021. Descriptive statistical analyses were performed and logistic regression was used to identify factors associated with neurological involvement. RESULTS One-hundred forty-seven (21%) of 697 hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Headache (n = 103), encephalopathy (n = 28), and seizures (n = 30) were the most reported. Neurological signs/symptoms were significantly associated with ICU admission (OR: 1.71, 95% CI: 1.15-2.55; p = 0.008), satisfaction of MIS-C criteria (OR: 3.71, 95% CI: 2.46-5.59; p < 0.001), fever during hospitalization (OR: 2.15, 95% CI: 1.46-3.15; p < 0.001), and gastrointestinal involvement (OR: 2.31, 95% CI: 1.58-3.40; p < 0.001). Non-headache neurological manifestations were significantly associated with ICU admission (OR: 1.92, 95% CI: 1.08-3.42; p = 0.026), underlying neurological disorders (OR: 2.98, 95% CI: 1.49-5.97, p = 0.002), and a history of fever prior to hospital admission (OR: 2.76, 95% CI: 1.58-4.82; p < 0.001). DISCUSSION In this study, approximately 21% of hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Future studies should focus on pathogenesis and long-term outcomes in these children.
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Affiliation(s)
- Carmen Yea
- Neuroscience and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
| | - Michelle Barton
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaun K. Morris
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Helena Brenes-Chacon
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Marcela Hernandez-de Mezerville
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Anari Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Dept. of Pediatrics, Montreal Children’s Hospital (McGill University Health Centre), Montreal, Quebec, Canada
- Division of Microbiology, Dept. of Clinical Laboratory Medicine, Optilab Montreal, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rosie Scuccimarri
- Division of Rheumatology, Montreal Children’s Hospital (McGill University Health Centre), Montreal, Quebec, Canada
| | - Marie-Astrid Lefebvre
- Division of Pediatric Infectious Diseases, Dept. of Pediatrics, Montreal Children’s Hospital (McGill University Health Centre), Montreal, Quebec, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Manish Sadarangani
- BC Children’s Hospital, Vancouver, BC, Canada
- Vaccine Evaluation Center, University of British Columbia, Vancouver, BC, Canada
| | | | - Jacqueline Wong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ontario, Canada
| | - Jennifer Bowes
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - E. Ann Yeh
- Neuroscience and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, The Hospital of Sick Children, Toronto, Ontario, Canada
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8
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Htun NSN, Perrone C, Phyo AP, Sen A, Phommasone K, Vanna M, Kanthawang N, Sappayabanphot J, Yotyingaphiram W, Wirachonphaophong J, Kabir N, Ol S, Xaiyaphet X, Soulivong A, Seevanhthong K, Tripura R, Chew R, Khirikoekkong N, Morris SK, Osterrieder A, Cheah PY, Jha P, Lubell Y, Peto TJ. Ethical and cultural implications for conducting verbal autopsies in South and Southeast Asia: a qualitative study. BMJ Glob Health 2023; 8:e013462. [PMID: 38081771 PMCID: PMC10729118 DOI: 10.1136/bmjgh-2023-013462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Causes of deaths often go unrecorded in lower income countries, yet this information is critical. Verbal autopsy is a questionnaire interview with a family member or caregiver to elicit the symptoms and circumstances preceding a death and assign a probable cause. The social and cultural aspects of verbal autopsy have gotten less attention than the technical aspects and have not been widely explored in South and Southeast Asia settings. METHODS Between October 2021 and March 2023, prior to implementing a verbal autopsy study at rural sites in Bangladesh, Cambodia, Laos, Myanmar and Thailand, focus group discussions were conducted with village heads, religious leaders and community members from varied demographic backgrounds. Thematic analysis elucidated customs and traditional views surrounding death to understand local ethnocultural sensitivities. RESULTS We found that death rituals varied greatly among religions, ethnicities and by socioeconomic status. Mourning periods were reported to last 3-100 days and related to the cause of death, age and how close the deceased person was to the family. Participants advised that interviews should happen after mourning periods to avoid emotional distress, but not long after so as to avoid recall bias. Interviewers should be introduced to respondents by a trusted local person. To provide reassurance and confidentiality, a family's residence is the preferred interview location. Interview questions require careful local language translation, and community sensitisation is important before data collection. CONCLUSION Verbal autopsy is acceptable across a wide range of cultural settings in Southeast Asia, provided that local norms are preidentified and followed.
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Affiliation(s)
- Nan Shwe Nwe Htun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Carlo Perrone
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Aninda Sen
- Communicable Diseases Programme, BRAC, Dhaka, Dhaka District, Bangladesh
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic
| | - Moul Vanna
- Action for Health Development, Battambang, Cambodia
| | - Nipaphan Kanthawang
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jarntrah Sappayabanphot
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | - Nawrin Kabir
- Communicable Diseases Programme, BRAC, Dhaka, Dhaka District, Bangladesh
| | - Sam Ol
- Action for Health Development, Battambang, Cambodia
| | - Xaipasong Xaiyaphet
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic
| | - Ailatda Soulivong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic
| | - Khambang Seevanhthong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic
| | - Rupam Tripura
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rusheng Chew
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Napat Khirikoekkong
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Shaun K Morris
- Division of Infectious Diseases, Child Health Evaluation Sciences and Centre for Global Child Health, Hospital for Sick Children, Toronto, Toronto, ON M5G 1E8, Canada
- University of Toronto Dalla Lana School of Public Health, Toronto, Toronto, ON M5T 3M7, Canada
| | - Anne Osterrieder
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Prabhat Jha
- University of Toronto Dalla Lana School of Public Health, Toronto, Toronto, ON M5T 3M7, Canada
- Centre for Global Health Research, St.Michael's Hospital, Toronto, Ontario, Canada
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas J Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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9
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Fadaleh SMA, Pell LG, Yasin M, Farrar DS, Khan SH, Tanner Z, Paracha S, Madhani F, Bassani DG, Ahmed I, Soofi SB, Taljaard M, Spitzer RF, Bhutta ZA, Morris SK. An integrated newborn care kit (iNCK) to save newborn lives and improve health outcomes in Gilgit Baltistan (GB), Pakistan: study protocol for a cluster randomized controlled trial. BMC Public Health 2023; 23:2480. [PMID: 38082395 PMCID: PMC10714624 DOI: 10.1186/s12889-023-17322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Ongoing high neonatal mortality rates (NMRs) represent a global challenge. In 2021, of the 5 million deaths reported worldwide for children under five years of age, 47% were newborns. Pakistan has one of the five highest national NMRs in the world, with an estimated 39 neonatal deaths per 1,000 live births. Reducing newborn deaths requires sustainable, evidence-based, and cost-effective interventions that can be integrated within existing community healthcare infrastructure across regions with high NMR. METHODS This pragmatic, community-based, parallel-arm, open-label, cluster randomized controlled trial aims to estimate the effect of Lady Health Workers (LHWs) providing an integrated newborn care kit (iNCK) with educational instructions to pregnant women in their third trimester, compared to the local standard of care in Gilgit-Baltistan, Pakistan, on neonatal mortality and other newborn and maternal health outcomes. The iNCK contains a clean birth kit, 4% chlorhexidine topical gel, sunflower oil emollient, a ThermoSpot™ temperature monitoring sticker, a fleece blanket, a click-to-heat reusable warmer, three 200 μg misoprostol tablets, and a pictorial instruction guide and diary. LHWs are also provided with a handheld scale to weigh the newborn. The primary study outcome is neonatal mortality, defined as a newborn death in the first 28 days of life. DISCUSSION This study will generate policy-relevant knowledge on the effectiveness of integrating evidence-based maternal and newborn interventions and delivering them directly to pregnant women via existing community health infrastructure, for reducing neonatal mortality and morbidity, in a remote, mountainous area with a high NMR. TRIAL REGISTRATION NCT04798833, March 15, 2021.
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Affiliation(s)
- Sarah M Abu Fadaleh
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lisa G Pell
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Muhammad Yasin
- Gilgit Regional Office, Aga Khan Health Service - Pakistan, Gilgit-Baltistan, Pakistan
| | - Daniel S Farrar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sher Hafiz Khan
- Gilgit Regional Office, Aga Khan Health Service - Pakistan, Gilgit-Baltistan, Pakistan
| | - Zachary Tanner
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Shariq Paracha
- Aga Khan Health Service - Pakistan, Karachi, Sindh, Pakistan
| | - Falak Madhani
- Aga Khan Health Service - Pakistan, Karachi, Sindh, Pakistan
- Brain and Mind Institute, Aga Khan University, Karachi, Sindh, Pakistan
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Research Institute, Toronto, ON, Canada
| | - Imran Ahmed
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sajid B Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Rachel F Spitzer
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Section of Gynecology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Research Institute, Toronto, ON, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
- Institute for Global Health & Development, The Aga Khan University, South-Central Asia & East Africa, Karachi, Pakistan
- Aga Khan University, Karachi, Sindh, Pakistan
| | - Shaun K Morris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Child Health Evaluative Sciences, The Hospital for Sick Children, Research Institute, Toronto, ON, Canada.
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
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10
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Condran B, Kervin M, Burton C, Blydt-Hansen TD, Morris SK, Sadarangani M, Otley A, Yong E, Mitchell H, Bettinger JA, Top KA. Parent and healthcare provider views of live varicella vaccination of pediatric solid organ transplant recipients. Pediatr Transplant 2023; 27:e14609. [PMID: 37746885 DOI: 10.1111/petr.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/28/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Live attenuated varicella vaccine (LAVV) has historically been contraindicated in children who are immunocompromised due to solid organ transplant (SOT) because of safety concerns. Recently, clinical guidelines were developed that support post-transplant varicella vaccination in selected SOT recipients based on emerging evidence of LAVV safety. This qualitative study sought to explore barriers and facilitators to implementing the new guidelines, as well as acceptability of LAVV among healthcare providers (HCPs) and parents. METHODS HCPs and parents of transplant recipients were recruited from four sites using purposive sampling. Data from semi-structured interviews were analyzed using an Interpretive Description approach that incorporated data from the interviews, academic knowledge and clinical experience, and drew from Grounded Theory and Thematic Analysis. The theoretical framework used was Adaptive Leadership. RESULTS Thirty-four participants (16 HCPs and 18 parents) were included in the analysis. Parents developed skills in adaptive leadership that included strategies to protect their child against infectious diseases. Foundational information that live vaccines were absolutely contraindicated post-transplant "stuck" with parents and led them to develop strategies other than vaccination to keep their child safe. Some parents struggled to understand that information previously presented as a certainty (contraindication of LAVV) could change. Their approach to adaptive leadership informed their appraisal of the new vaccination guidelines and willingness to accept vaccination. CONCLUSIONS HCPs should adopt a family-centered approach to communicating changing guidelines that considers parents' approach to adaptive leadership and discusses the changing nature of medical evidence. Trust between HCPs and parents can facilitate these conversations.
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Affiliation(s)
- Brian Condran
- Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada
| | - Melissa Kervin
- Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada
| | - Catherine Burton
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaun K Morris
- Clinical Public Health and Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases and Child Health Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Manish Sadarangani
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Anthony Otley
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Hana Mitchell
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Julie A Bettinger
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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11
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Schober T, Morris SK, Bettinger JA, Burton C, Halperin SA, Jadavji T, Kazmi K, Modler J, Sadarangani M, Papenburg J. Antibiotic use in children hospitalised for influenza, 2010-2021: the Canadian Immunization Monitoring Program Active (IMPACT). Infection 2023:10.1007/s15010-023-02124-6. [PMID: 37930625 DOI: 10.1007/s15010-023-02124-6] [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: 09/12/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE To determine characteristics associated with inappropriate antibiotic use amongst children hospitalised for influenza. METHODS We performed active surveillance for laboratory-confirmed influenza hospitalizations amongst children ≤ 16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, from September 2010 to August 2021. Antibiotic use was presumed appropriate if any of the following indications were met: age < 1 month, immunocompromised, hemoglobinopathy, laboratory-confirmed bacterial infection, radiographically confirmed pneumonia, admission to an intensive care unit and mechanical ventilation. Regression analyses were used to identify baseline and clinical characteristics associated with antibiotic use amongst patients without an appropriate indication. RESULTS Amongst 8971 children, 6424 (71.6%) received any antibiotics during their hospitalisation. Amongst the 4429 children without an appropriate indication, 2366 (53.2%) received antibiotics. Antibiotic use amongst children without appropriate indication differed between study centres, ranging from 33.2% to 66.1% (interquartile range [IQR] 50.6-56.3%); it did not change significantly over time (p-value for trend = 0.28). In multivariable analyses, older age (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.96-0.99), presence of any high-risk condition (aOR 0.80, 95% CI 0.70-0.92), influenza virus type B (aOR 0.8, 95% CI 0.70-0.91) and croup (aOR 0.64, 95% CI 0.49-0.83) were associated with less, whilst fever ≥ 38.5 °C (aOR 1.82, 95% CI 1.42-2.35) and hospitalisation duration (aOR 1.12, 95% CI 1.09-1.15) were associated with more inappropriate antibiotic use. CONCLUSIONS Over two-third of children hospitalised for influenza received antibiotics, including over half of those without an appropriate indication for antibiotic treatment. Differences amongst study centres suggest the importance of contextual determinants of antibiotic use.
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Affiliation(s)
- Tilmann Schober
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, E05.1905, 1001 Décarie Blvd, Montreal, QC, H4A 3J1, Canada
- Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Shaun K Morris
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute,, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Burton
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - Taj Jadavji
- Section of Infectious Diseases, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Kescha Kazmi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jacqueline Modler
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute,, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, E05.1905, 1001 Décarie Blvd, Montreal, QC, H4A 3J1, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada.
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, QC, Canada.
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12
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El Tal T, Morin MP, Morris SK, Farrar DS, Berard RA, Kakkar F, Moore Hepburn C, Baerg K, Beaufils C, Bennett TL, Benseler SM, Beaudoin-Bussières G, Chan K, Cyr C, Dahdah N, Donner EJ, Drouin O, Edjoc R, Eljaouhari M, Embree JE, Farrell C, Finzi A, Forgie S, Giroux R, Kang KT, King M, Laffin Thibodeau M, Lang B, Laxer RM, Luu TM, McCrindle BW, Orkin J, Papenburg J, Pound CM, Price VE, Proulx-Gauthier JP, Purewal R, Sadarangani M, Salvadori MI, Thibeault R, Top KA, Viel-Thériault I, Haddad E, Scuccimarri R, Yeung RSM. Paediatric inflammatory multisystem syndrome in Canada: population-based surveillance and role of SARS-CoV-2 linkage. Pediatr Res 2023; 94:1744-1753. [PMID: 37277605 PMCID: PMC10241135 DOI: 10.1038/s41390-023-02668-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Paediatric inflammatory multisystem syndrome (PIMS) is a rare condition temporally associated with SARS-CoV-2 infection. Using national surveillance data, we compare presenting features and outcomes among children hospitalized with PIMS by SARS-CoV-2 linkage, and identify risk factors for intensive care (ICU). METHODS Cases were reported to the Canadian Paediatric Surveillance Program by a network of >2800 pediatricians between March 2020 and May 2021. Patients with positive versus negative SARS-CoV-2 linkages were compared, with positive linkage defined as any positive molecular or serologic test or close contact with confirmed COVID-19. ICU risk factors were identified with multivariable modified Poisson regression. RESULTS We identified 406 children hospitalized with PIMS, including 49.8% with positive SARS-CoV-2 linkages, 26.1% with negative linkages, and 24.1% with unknown linkages. The median age was 5.4 years (IQR 2.5-9.8), 60% were male, and 83% had no comorbidities. Compared to cases with negative linkages, children with positive linkages experienced more cardiac involvement (58.8% vs. 37.4%; p < 0.001), gastrointestinal symptoms (88.6% vs. 63.2%; p < 0.001), and shock (60.9% vs. 16.0%; p < 0.001). Children aged ≥6 years and those with positive linkages were more likely to require ICU. CONCLUSIONS Although rare, 30% of PIMS hospitalizations required ICU or respiratory/hemodynamic support, particularly those with positive SARS-CoV-2 linkages. IMPACT We describe 406 children hospitalized with paediatric inflammatory multisystem syndrome (PIMS) using nationwide surveillance data, the largest study of PIMS in Canada to date. Our surveillance case definition of PIMS did not require a history of SARS-CoV-2 exposure, and we therefore describe associations of SARS-CoV-2 linkages on clinical features and outcomes of children with PIMS. Children with positive SARS-CoV-2 linkages were older, had more gastrointestinal and cardiac involvement, and hyperinflammatory laboratory picture. Although PIMS is rare, one-third required admission to intensive care, with the greatest risk amongst those aged ≥6 years and those with a SARS-CoV-2 linkage.
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Affiliation(s)
- Tala El Tal
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Marie-Paule Morin
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Shaun K Morris
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada.
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Daniel S Farrar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Roberta A Berard
- Division of Rheumatology, Department of Pediatrics, London Health Sciences Centre, London, ON, Canada
| | - Fatima Kakkar
- Division of Infectious Diseases, CHU Sainte-Justine, Montreal, QC, Canada
| | - Charlotte Moore Hepburn
- Department of Pediatrics, Division of Paediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Krista Baerg
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
- Division of General Pediatrics, Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Camille Beaufils
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | | | - Susanne M Benseler
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Guillaume Beaudoin-Bussières
- Department of Microbiology, Immunology and Infectious Diseases, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du CHUM, Montreal, QC, Canada
| | - Kevin Chan
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Children's and Women's Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Claude Cyr
- Service de Soins Intensifs Pédiatriques, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Elizabeth J Donner
- Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Olivier Drouin
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | | | | | - Joanne E Embree
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Catherine Farrell
- Division of Paediatric Intensive Care, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Andrés Finzi
- Department of Microbiology, Immunology and Infectious Diseases, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du CHUM, Montreal, QC, Canada
| | - Sarah Forgie
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, AB, Canada
| | - Ryan Giroux
- Women's and Children's Health Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Kristopher T Kang
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Melanie King
- Canadian Paediatric Surveillance Program, Canadian Paediatric Society, Ottawa, ON, Canada
| | | | - Bianca Lang
- Division of Rheumatology, Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Ronald M Laxer
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Thuy Mai Luu
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Brian W McCrindle
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Julia Orkin
- Department of Pediatrics, Division of Paediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Catherine M Pound
- Division of Consulting Pediatrics, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Victoria E Price
- Division of Paediatric Hematology/Oncology, Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | | | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
- Division of Paediatric Infectious Diseases, Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Manish Sadarangani
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | - Roseline Thibeault
- Division of Pediatric Infectious Diseases, Department of Paediatrics, CHU de Quebec-University of Laval, Quebec City, QC, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Isabelle Viel-Thériault
- Division of Infectious Diseases, Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Elie Haddad
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, QC, Canada.
| | - Rosie Scuccimarri
- Division of Paediatric Rheumatology, Montreal Children's Hospital/McGill University Health Centre, Montreal, QC, Canada
| | - Rae S M Yeung
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
- Cell Biology Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
- Department of Immunology and Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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13
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Piché-Renaud PP, Yue Lee E, Ji C, Qing Huang JY, Uleryk E, Teoh CW, Morris SK, Top KA, Upton JEM, Vyas MV, Allen UD. Safety and immunogenicity of the live-attenuated varicella vaccine in pediatric solid organ transplant recipients: A systematic review and meta-analysis. Am J Transplant 2023; 23:1757-1770. [PMID: 37321454 DOI: 10.1016/j.ajt.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
This study aimed to synthesize the available evidence on the immunogenicity, safety, and effectiveness of live-attenuated varicella vaccine in solid organ transplant recipients. Medline and EMBASE were searched using predefined search terms to identify relevant studies. The included articles reported varicella vaccine administration in the posttransplant period in children and adults. A pooled proportion of transplant recipients who seroconverted and who developed vaccine-strain varicella and varicella disease was generated. Eighteen articles (14 observational studies and 4 case reports) were included, reporting on 711 transplant recipients who received the varicella vaccine. The pooled proportion was 88.2% (95% confidence interval 78.0%-96.0%, 13 studies) for vaccinees who seroconverted, 0% (0%-1.2%, 13 studies) for vaccine-strain varicella, and 0.8% (0%-4.9%, 9 studies) for varicella disease. Most studies followed clinical guidelines for administering live-attenuated vaccines, with criteria that could include being at least 1 year posttransplant, 2 months postrejection episode, and on low-dose immunosuppressive medications. Varicella vaccination in transplant recipients was overall safe in the included studies, with few cases of vaccine-strain-induced varicella or vaccine failure, and although it was immunogenic, the proportion of recipients who seroconverted was lower than that seen in the general population. Our data support varicella vaccination in select pediatric solid organ transplant recipients.
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Affiliation(s)
- Pierre-Philippe Piché-Renaud
- Division of Infectious Diseases, the Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Erika Yue Lee
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Clinical Immunology and Allergy, St. Michael's Hospital, Toronto, Ontario, Canada; Eliot Phillipson Clinician Scientist Training Program, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Ji
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
| | - Jenny Yu Qing Huang
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Chia Wei Teoh
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, the Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Global Child Health, the Hospital for Sick Children, Toronto, Ontario, Canada; Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Karina A Top
- Departments of Pediatrics and Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia E M Upton
- Division of Immunology and Allergy, Department of Paediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manav V Vyas
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Upton D Allen
- Division of Infectious Diseases, the Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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14
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Muñoz CE, Pham-Huy A, Pernica JM, Boucher FD, De Serres G, Vaudry W, Constantinescu C, Sadarangani M, Bettinger JA, Tapiéro B, Morris SK, McConnell A, Noya F, Halperin SA, Top KA. Factors associated with intention for revaccination among patients with adverse events following immunization. Vaccine 2023; 41:6239-6247. [PMID: 37666696 DOI: 10.1016/j.vaccine.2023.08.067] [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: 05/19/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Individuals and healthcare providers may be uncertain about the safety of revaccination after an adverse event following immunization (AEFI). We identified factors associated with physician recommendation for revaccination and participant intention to be revaccinated among patients with adverse events following immunization (AEFIs) assessed in the Canadian Special Immunization Clinic (SIC) Network from 2013 to 2019. METHODS This prospective observational study included patients assessed in the Canadian Special Immunization Clinic Network from 2013 to 2019 for an AEFI who required additional doses of the vaccine temporally associated with their AEFI. Participants underwent standardized assessment and data collection. Physician recommendations regarding revaccination and participant intent for revaccination were recorded. AEFI impact on daily activities and need for medical attention was captured as low, moderate, high impact and serious (e.g., requiring hospitalization). Multivariable logistic regression analysis identified factors associated with physician recommendation and participant intention for revaccination, controlling for province of assessment. RESULTS Physician recommendation was significantly associated with the type of AEFI and AEFI impact. Compared to large local reaction, physician recommendation for revaccination was reduced for immediate hypersensitivity (aOR: 0.24 [95% CI: 0.08-0.76]) and new onset autoimmune disease (aOR: 0.16; 95% CI: 0.04-0.69). Compared to low impact AEFIs, physician recommendation was reduced for moderate (aOR: 0.22 [95% CI: 0.07-0.65]), high impact (aOR: 0.08 [95% CI: 0.02-0.30]), and serious AEFIs (aOR: 0.11 [95% CI: 0.03-0.37]). Participant intention for revaccination was significantly associated with AEFI impact, with reduced odds for high versus low impact AEFIs (aOR: 0.12 [95% CI: 0.04-0.42]). CONCLUSION Physicians appear to use AEFI type and impact to guide recommendations while patients use primarily AEFI impact to form intentions for revaccination. The findings may help inform counselling for patients with AEFIs.
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Affiliation(s)
- Caroline E Muñoz
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada; Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne Pham-Huy
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey M Pernica
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - François D Boucher
- Centre hospitalier universitaire de Québec-Université Laval, Québec, Québec, Canada
| | - Gaston De Serres
- Centre hospitalier universitaire de Québec-Université Laval, Québec, Québec, Canada
| | - Wendy Vaudry
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Cora Constantinescu
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce Tapiéro
- Division of Infectious Diseases, CHU Sainte Justine, Université de Montréal, Montréal QC, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Athena McConnell
- Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Francisco Noya
- Division of Allergy and Immunology and Division of Infectious Diseases, Montreal Children's Hospital-McGill University Health Centre, Montreal, QC, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University, Canada
| | - Karina A Top
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada; Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University, Canada.
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15
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Bourdeau M, Vadlamudi NK, Bastien N, Embree J, Halperin SA, Jadavji T, Kazmi K, Langley JM, Lebel MH, Le Saux N, Moore D, Morris SK, Pernica JM, Robinson J, Sadarangani M, Bettinger JA, Papenburg J. Pediatric RSV-Associated Hospitalizations Before and During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2336863. [PMID: 37792376 PMCID: PMC10551765 DOI: 10.1001/jamanetworkopen.2023.36863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023] Open
Abstract
Importance Respiratory syncytial virus (RSV) is a leading cause of pediatric hospitalizations. Objective To describe the epidemiology and burden of RSV-associated hospitalizations among children and adolescents in Canadian tertiary pediatric hospitals from 2017 to 2022, including changes during the COVID-19 pandemic. Design, Setting, and Participants This cross-sectional study was conducted during 5 RSV seasons (2017-2018 to 2021-2022) at 13 pediatric tertiary care centers from the Canadian Immunization Monitoring Program Active (IMPACT) program. Hospitalized children and adolescents aged 0 to 16 years with laboratory-confirmed RSV infection were included. Main Outcomes and Measures The proportion of all-cause admissions associated with RSV and counts and proportions of RSV hospitalizations with intensive care unit (ICU) admission, prolonged stay (≥7 days), and in-hospital mortality were calculated overall and by season, age group, and region. Seasonality was described using epidemic curves. RSV hospitalizations for 2021-2022 were compared with those in the prepandemic period of 2017-2018 through 2019-2020. Bonferroni corrections were applied to P values to adjust for multiple statistical comparisons. Results Among 11 014 RSV-associated hospitalizations in children and adolescents (6035 hospitalizations among male patients [54.8%]; 5488 hospitalizations among patients aged <6 months [49.8%]), 2594 hospitalizations (23.6%) had admission to the ICU, of which 1576 hospitalizations (60.8%) were among children aged less than 6 months. The median (IQR) hospital stay was 4 (2-6) days. The mean (SD) number of RSV-associated hospitalizations during prepandemic seasons was 2522 (88.8) hospitalizations. There were 58 hospitalizations reported in 2020-2021, followed by 3170 hospitalizations in 2021-2022. The proportion of all-cause hospitalizations associated with RSV increased from a mean of 3.2% (95% CI, 3.1%-3.3%) before the pandemic to 4.5% (95% CI, 4.3%-4.6%) in 2021-2022 (difference, 1.3 percentage points; 95% CI, 1.1-1.5 percentage points; corrected P < .001). A significant increase in RSV-associated hospitalizations was found in 2021-2022 for 3 provinces (difference range, 2.5 percentage points; 95% CI, 1.4-3.6 percentage points for Quebec to 2.9 percentage points; 95% CI, 1.4-3.5 percentage points for Alberta; all corrected P < .001). Age, sex, ICU admission, prolonged length of stay, and case fatality rate did not change in 2021-2022 compared with the prepandemic period. Interregional differences in RSV seasonality were accentuated in 2021-2022, with peaks for 1 province in October, 4 provinces in December, and 3 provinces in April, or May. Conclusions and Relevance This study found that the burden of RSV-associated hospitalizations in Canadian pediatric hospitals was substantial, particularly among infants aged less than 6 months, and RSV hospitalizations increased in 2021-2022 compared with the prepandemic period, while severity of illness remained similar. These findings suggest that RSV preventive strategies for infants aged less than 6 months would be associated with decreased RSV disease burden in children.
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Affiliation(s)
- Malou Bourdeau
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Nirma Khatri Vadlamudi
- Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Joanne Embree
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott A. Halperin
- Canadian Center for Vaccinology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Taj Jadavji
- Section of Infectious Diseases, Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Kescha Kazmi
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joanne M. Langley
- Canadian Center for Vaccinology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marc H. Lebel
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Sainte-Justine, Montreal, Quebec, Canada
| | - Nicole Le Saux
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Dorothy Moore
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Shaun K. Morris
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey M. Pernica
- Division of Infectious Diseases, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Manish Sadarangani
- Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie A. Bettinger
- Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jesse Papenburg
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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16
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Chen X, Porter A, Abdur Rehman N, Morris SK, Saif U, Chunara R. Area-based determinants of outreach vaccination for reaching vulnerable populations: A cross-sectional study in Pakistan. PLOS Glob Public Health 2023; 3:e0001703. [PMID: 37756308 PMCID: PMC10529552 DOI: 10.1371/journal.pgph.0001703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 08/16/2023] [Indexed: 09/29/2023]
Abstract
The objective of this study is to gain a comparative understanding of spatial determinants for outreach and clinic vaccination, which is critical for operationalizing efforts and breaking down structural biases; particularly relevant in countries where resources are low, and sub-region variance is high. Leveraging a massive effort to digitize public system reporting by Lady and Community Health Workers (CHWs) with geo-located data on over 4 million public-sector vaccinations from September 2017 through 2019, understanding health service operations in relation to vulnerable spatial determinants were made feasible. Location and type of vaccinations (clinic or outreach) were compared to regional spatial attributes where they were performed. Important spatial attributes were assessed using three modeling approaches (ridge regression, gradient boosting, and a generalized additive model). Consistent predictors for outreach, clinic, and proportion of third dose pentavalent vaccinations by region were identified. Of all Penta-3 vaccination records, 86.3% were performed by outreach efforts. At the tehsil level (fourth-order administrative unit), controlling for child population, population density, proportion of population in urban areas, distance to cities, average maternal education, and other relevant factors, increased poverty was significantly associated with more in-clinic vaccinations (β = 0.077), and lower proportion of outreach vaccinations by region (β = -0.083). Analyses at the union council level (fifth-administrative unit) showed consistent results for the differential importance of poverty for outreach versus clinic vaccination. Relevant predictors for each type of vaccination (outreach vs. in-clinic) show how design of outreach vaccination can effectively augment vaccination efforts beyond healthcare services through clinics. As Pakistan is third among countries with the most unvaccinated and under-vaccinated children, understanding barriers and factors associated with vaccination can be demonstrative for other national and sub-national regions facing challenges and also inform guidelines on supporting CHWs in health systems.
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Affiliation(s)
- Xiaoting Chen
- Department of Biostatistics, New York University, New York, New York, United States of America
| | - Allan Porter
- Department of Computer Science Engineering, New York University, Brooklyn, New York, United States of America
| | - Nabeel Abdur Rehman
- Department of Computer Science Engineering, New York University, Brooklyn, New York, United States of America
| | - Shaun K. Morris
- Division of Infectious Diseases and Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Umar Saif
- UNESCO Chair for ICTD, Lahore, Pakistan
| | - Rumi Chunara
- Department of Biostatistics, New York University, New York, New York, United States of America
- Department of Computer Science Engineering, New York University, Brooklyn, New York, United States of America
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17
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Hui C, Bosch A, Mwizerwa O, McColl J, Corbeil A, Malcolmson C, Levy DM, Bismilla Z, Morris SK. Case Report: A Case of Bone Marrow Necrosis and Hyperinflammation in a 10-Year-Old Boy after Plasmodium falciparum Infection. Am J Trop Med Hyg 2023; 109:611-615. [PMID: 37487563 PMCID: PMC10484272 DOI: 10.4269/ajtmh.22-0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/14/2023] [Indexed: 07/26/2023] Open
Abstract
A 10-year-old boy with sickle cell disease (SCD) type SC presented with fever and abdominal pain after travel to Ghana and was diagnosed with Plasmodium falciparum infection. Despite adequate antimalarial treatment, he developed evidence of hyperinflammation with marked elevated ferritin, C-reactive protein, and triglycerides and subsequent bone marrow necrosis, characterized by elevated nucleated red blood cells and significant bone pain. This case report highlights the possible association between malaria and bone marrow necrosis in patients with SCD. Important considerations in treatment and workup of patients presenting with malaria and hyperinflammation are discussed.
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Affiliation(s)
- Caitlyn Hui
- Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada
| | - Alessandra Bosch
- Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada
- The Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Oscar Mwizerwa
- Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada
- Division of Pediatric Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - Jeanine McColl
- Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada
- Division of Pediatric Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - Antoine Corbeil
- Microbiology and Laboratory Science, Public Health Ontario, Toronto, Canada
| | - Caroline Malcolmson
- Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada
- The Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Deborah M. Levy
- Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada
- Division of Pediatric Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - Zia Bismilla
- Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Shaun K. Morris
- Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, The University of Toronto, Toronto, Canada
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Fitzpatrick T, Alsager K, Sadarangani M, Pham-Huy A, Murguía-Favela L, Morris SK, Seow CH, Piché-Renaud PP, Jadavji T, Vanderkooi OG, Top KA, Constantinescu C. Immunological effects and safety of live rotavirus vaccination after antenatal exposure to immunomodulatory biologic agents: a prospective cohort study from the Canadian Immunization Research Network. Lancet Child Adolesc Health 2023; 7:648-656. [PMID: 37390832 DOI: 10.1016/s2352-4642(23)00136-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND People with inflammatory or autoimmune diseases are recommended to continue immunomodulatory biologic agents throughout pregnancy. However, concerns regarding potential immunosuppression in infants exposed to biologic agents have led to recommendations to avoid live vaccines in the first 6-12 months of life. We aimed to examine whether live rotavirus vaccine could be administered safely to infants exposed to biologic agents, assessed in the Canadian Special Immunization Clinic (SIC) Network. METHODS In this prospective cohort study, infants exposed to biologic agents in utero were referred to one of six SIC sites in Canada for rotavirus vaccination recommendations. Children with other contraindications to rotavirus vaccination or older than 15 weeks were excluded. Clinical and laboratory evaluations were conducted according to a standard clinical pathway. Data were collected for relevant medical history, pregnancy outcomes, biologic agent exposure history, physical examination, laboratory results of the child, SIC recommendations for rotavirus vaccination, rotavirus vaccine series completion, and adverse events after immunisation. After parental consent, deidentified data were transferred to a central database for analysis. Children recommended for rotavirus vaccination were followed up for 8 months after series initiation to ascertain severe and serious adverse events, including severe diarrhoea, vomiting, and intussusception. FINDINGS Between May 1, 2017, and Dec 31, 2021, 202 infants were assessed and 191 eligible infants were enrolled (97 [51%] were female and 94 [49%] were male). When including those exposed to multiple agents, the most common biologic agents to which infants were exposed were infliximab (67 [35%] of 191), adalimumab (49 [26%]), ustekinumab (18 [9%]), and vedolizumab (17 [9%]). Biologic agent exposure continued into the third trimester for 178 (93%) infants. No clinically significant abnormalities in lymphocyte subsets, quantitative immunoglobulins, or mitogen responses were detected. After SIC assessment, rotavirus vaccination was recommended for 187 (98%) of 191 infants, all of whom were followed up. By end of follow-up on Aug 19, 2022, 168 (90%) infants had initiated rotavirus vaccination; 150 (80%) completed the series. No serious adverse events after immunisation were reported, but three (2%) infants required medical attention, one for vomiting and change in stools who was subsequently diagnosed with gastroesophageal reflux disease, one for rash on labia unrelated to vaccination, and one for vomiting and diarrhoea associated with a milk allergy. INTERPRETATION Findings from this study suggest that lymphocyte subsets and the safety of live rotavirus vaccination are generally not affected by in-utero exposure to biologic agents. Rotavirus vaccination can be offered to infants exposed to anti-TNF agents in utero. FUNDING Public Health Agency of Canada and Canadian Institutes of Health Research through the Canadian Immunization Research Network.
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Affiliation(s)
- Tiffany Fitzpatrick
- Canadian Center for Vaccinology, IWK Health, Halifax, NS, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Khaled Alsager
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Pediatric Infectious Diseases Division, Pediatric Department, King Abdullah Specialized Children's Hospital, Ministry of National Guard Hospital Affairs, Riyadh, Saudi Arabia
| | - Manish Sadarangani
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Anne Pham-Huy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Luis Murguía-Favela
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Shaun K Morris
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Cynthia H Seow
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Tajdin Jadavji
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Otto G Vanderkooi
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, IWK Health, Halifax, NS, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada; Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
| | - Cora Constantinescu
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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19
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Di Chiara C, Ponzoni M, Piché-Renaud PP, Mengato D, Giaquinto C, Morris SK, Donà D. Alternative Antimicrobial Irrigation Strategies for the Treatment of Infections in Children: A Review of the Existing Literature. Antibiotics (Basel) 2023; 12:1271. [PMID: 37627691 PMCID: PMC10451316 DOI: 10.3390/antibiotics12081271] [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: 07/09/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
As a synergistic treatment approach with systemic antimicrobial therapy or a systemic antibiotic-sparing strategy, the local administration of antimicrobial agents has been proposed as an alternative route for complicated infections. With the rationale of concentrating the active principle in the desired target site, avoiding potentially toxic systemic levels and bypassing anatomical and physiological barriers, local irrigation or infusion of antibiotics may effectively shorten the antimicrobial therapy course and reduce both infection-related and systemic therapy-related complications. Although evidence from the adult population supports its use in selected patients with an acceptable safety profile, data specifically focused on the pediatric population are limited. To provide a rapid and easily accessible tool for clinical practice, we synthesized the most relevant evidence on the use of local antimicrobial agents in common severe infections in children: meningitis, mediastinitis, pleural infections, recurrent urinary infections, and peritonitis. A literature search was performed using predefined combined keywords through an electronic research database (PubMed). Described molecules, dosages, routes, treated age groups, and related efficacy have been summarized for prompt application to clinical practice. It should, however, be noted that the evidence for the pediatric population remains limited, and the local administration of several molecules remains off-label. A careful multidisciplinary and patient-tailored evaluation, as well as a rational use of available guidelines, should always be the basis of clinical decision making in settings where local administration of antibiotics may be considered.
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Affiliation(s)
- Costanza Di Chiara
- Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (C.G.); (D.D.)
- Penta—Child Health Research, 35127 Padua, Italy
- Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.-P.P.-R.); (S.K.M.)
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Matteo Ponzoni
- Congenital Cardiac Surgery Unit, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Pierre-Philippe Piché-Renaud
- Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.-P.P.-R.); (S.K.M.)
| | - Daniele Mengato
- Hospital Pharmacy Department, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy;
| | - Carlo Giaquinto
- Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (C.G.); (D.D.)
- Penta—Child Health Research, 35127 Padua, Italy
| | - Shaun K. Morris
- Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.-P.P.-R.); (S.K.M.)
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5R 0A3, Canada
- Division of Clinical Public Health and Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, Toronto, ON M5T 3M7, Canada
| | - Daniele Donà
- Department for Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (C.G.); (D.D.)
- Penta—Child Health Research, 35127 Padua, Italy
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20
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Yoo S, Garg E, Elliott LT, Hung RJ, Halevy AR, Brooks JD, Bull SB, Gagnon F, Greenwood C, Lawless JF, Paterson AD, Sun L, Zawati MH, Lerner-Ellis J, Abraham R, Birol I, Bourque G, Garant JM, Gosselin C, Li J, Whitney J, Thiruvahindrapuram B, Herbrick JA, Lorenti M, Reuter MS, Adeoye OO, Liu S, Allen U, Bernier FP, Biggs CM, Cheung AM, Cowan J, Herridge M, Maslove DM, Modi BP, Mooser V, Morris SK, Ostrowski M, Parekh RS, Pfeffer G, Suchowersky O, Taher J, Upton J, Warren RL, Yeung R, Aziz N, Turvey SE, Knoppers BM, Lathrop M, Jones S, Scherer SW, Strug LJ. HostSeq: a Canadian whole genome sequencing and clinical data resource. BMC Genom Data 2023; 24:26. [PMID: 37131148 PMCID: PMC10152008 DOI: 10.1186/s12863-023-01128-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/22/2023] [Indexed: 05/04/2023] Open
Abstract
HostSeq was launched in April 2020 as a national initiative to integrate whole genome sequencing data from 10,000 Canadians infected with SARS-CoV-2 with clinical information related to their disease experience. The mandate of HostSeq is to support the Canadian and international research communities in their efforts to understand the risk factors for disease and associated health outcomes and support the development of interventions such as vaccines and therapeutics. HostSeq is a collaboration among 13 independent epidemiological studies of SARS-CoV-2 across five provinces in Canada. Aggregated data collected by HostSeq are made available to the public through two data portals: a phenotype portal showing summaries of major variables and their distributions, and a variant search portal enabling queries in a genomic region. Individual-level data is available to the global research community for health research through a Data Access Agreement and Data Access Compliance Office approval. Here we provide an overview of the collective project design along with summary level information for HostSeq. We highlight several statistical considerations for researchers using the HostSeq platform regarding data aggregation, sampling mechanism, covariate adjustment, and X chromosome analysis. In addition to serving as a rich data source, the diversity of study designs, sample sizes, and research objectives among the participating studies provides unique opportunities for the research community.
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Affiliation(s)
- S Yoo
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - E Garg
- Simon Fraser University, Burnaby, BC, Canada
| | - L T Elliott
- Simon Fraser University, Burnaby, BC, Canada
| | - R J Hung
- University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - A R Halevy
- The Hospital for Sick Children, Toronto, ON, Canada
| | - J D Brooks
- University of Toronto, Toronto, ON, Canada
| | - S B Bull
- University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - F Gagnon
- University of Toronto, Toronto, ON, Canada
| | - Cmt Greenwood
- McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - J F Lawless
- University of Waterloo, Waterloo, ON, Canada
| | - A D Paterson
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - L Sun
- University of Toronto, Toronto, ON, Canada
| | | | - J Lerner-Ellis
- University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | - Rjs Abraham
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - I Birol
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - G Bourque
- McGill University, Montreal, QC, Canada
| | - J-M Garant
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - C Gosselin
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - J Li
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - J Whitney
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - J-A Herbrick
- The Hospital for Sick Children, Toronto, ON, Canada
| | - M Lorenti
- The Hospital for Sick Children, Toronto, ON, Canada
| | - M S Reuter
- The Hospital for Sick Children, Toronto, ON, Canada
| | - O O Adeoye
- The Hospital for Sick Children, Toronto, ON, Canada
| | - S Liu
- The Hospital for Sick Children, Toronto, ON, Canada
| | - U Allen
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - F P Bernier
- University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital, Calgary, AB, Canada
| | - C M Biggs
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
| | - A M Cheung
- University Health Network, Toronto, ON, Canada
| | - J Cowan
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Herridge
- University Health Network, Toronto, ON, Canada
| | | | - B P Modi
- BC Children's Hospital, Vancouver, BC, Canada
| | - V Mooser
- McGill University, Montreal, QC, Canada
| | - S K Morris
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - M Ostrowski
- University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - R S Parekh
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - G Pfeffer
- University of Calgary, Calgary, AB, Canada
| | | | - J Taher
- University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | - J Upton
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - R L Warren
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Rsm Yeung
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - N Aziz
- The Hospital for Sick Children, Toronto, ON, Canada
| | - S E Turvey
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | | | - M Lathrop
- McGill University, Montreal, QC, Canada
| | - Sjm Jones
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - S W Scherer
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - L J Strug
- The Hospital for Sick Children, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
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21
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Conforti C, Krueger C, Branson HM, Manson D, Morris SK, Yama BA. Severe Back Pain and Fever in a 9-year-old Boy. Pediatr Rev 2023; 44:286-289. [PMID: 37122045 DOI: 10.1542/pir.2021-005170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Celine Conforti
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, and
| | - Carsten Krueger
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, and
| | - Helen M Branson
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging
| | - David Manson
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging
| | - Shaun K Morris
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, and
- Division of Infectious Diseases
| | - Brie A Yama
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, and
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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22
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Schober T, Morris SK, Bettinger JA, Bancej C, Burton C, Foo C, Halperin SA, Jadavji T, Kazmi K, Modler J, Sadarangani M, Papenburg J. Outcomes of immunocompromised children hospitalized for influenza, 2010-2021, the Canadian Immunization Monitoring program active (IMPACT). Clin Microbiol Infect 2023:S1198-743X(23)00153-2. [PMID: 37054913 DOI: 10.1016/j.cmi.2023.04.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/21/2023] [Accepted: 04/01/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES To evaluate immunocompromising conditions and subgroups of immunocompromise as risk factors for severe outcomes among children admitted for influenza. METHODS We performed active surveillance for laboratory-confirmed influenza hospitalizations among children ≤16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, during 2010-2021. Logistic regression analyses were used to compare outcomes between immunocompromised and non-immunocompromised children, and for different subgroups of immunocompromise. The primary outcome was intensive care unit (ICU) admission; secondary outcomes were mechanical ventilation and death. RESULTS Among 8982 children, 892 (9.9%) were immunocompromised; these patients were older (median 5.6 [IQR 3.1 - 10.0] vs 2.4 [1 -6] years, p<0.001) than non-immunocompromised children, had similar frequency of comorbidities excluding immunocompromise and/or malignancy (38% [340/892) vs 40% [3272/8090], p=0.2), but fewer respiratory symptoms, such as respiratory distress (20% [177/892] vs 42% [3424/8090], p<0.001). In multivariable analyses, immunocompromise (adjusted odds ratio [aOR] 0.19, 95% CI 0.14-0.25) and its subcategories immunodeficiency (aOR 0.16, 95% CI 0.10-0.23), immunosuppression (aOR 0.17, 95% CI 0.12-0.23), chemotherapy (aOR 0.07, 95% CI 0.03-0.13) and solid organ transplantation (aOR 0.17, 95% CI 0.06-0.37) were associated with decreased probability of ICU admission in children admitted for influenza. Immunocompromise was also associated with decreased probability for mechanical ventilation (aOR 0.26, 95% CI 0.16-0.38) or death (aOR 0.22, 95% CI 0.03-0.72). CONCLUSIONS Immunocompromised children are overrepresented among hospitalizations for influenza, but have decreased probability of ICU admission, mechanical ventilation, and mortality following admission. Admission bias precludes generalizability beyond the hospital setting.
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Affiliation(s)
- Tilmann Schober
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Shaun K Morris
- Division of Pediatric Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christina Bancej
- Center for Immunization & Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada
| | - Catherine Burton
- Division of Pediatric Infectious Diseases, Department of Paediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl Foo
- Pediatric Infectious Diseases, Janeway Children's Health and Rehabilitation Centre, Eastern Health Regional Authority, St. John's, Newfoundland and Labrador, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Taj Jadavji
- Section of Infectious Diseases, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Kescha Kazmi
- Division of Pediatric Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline Modler
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada; Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
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23
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Piché-Renaud PP, Swayze S, Buchan SA, Wilson SE, Austin PC, Morris SK, Nasreen S, Schwartz KL, Tadrous M, Thampi N, Wilson K, Kwong JC. COVID-19 Vaccine Effectiveness Against Omicron Infection and Hospitalization. Pediatrics 2023; 151:190808. [PMID: 36866446 DOI: 10.1542/peds.2022-059513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVES This study aimed to provide real-world evidence on coronavirus disease 2019 vaccine effectiveness (VE) against symptomatic infection and severe outcomes caused by Omicron in children aged 5 to 11 years. METHODS We used the test-negative study design and linked provincial databases to estimate BNT162b2 vaccine effectiveness against symptomatic infection and severe outcomes caused by Omicron in children aged 5 to 11 years between January 2 and August 27, 2022 in Ontario. We used multivariable logistic regression to estimate VE by time since the latest dose, compared with unvaccinated children, and we evaluated VE by dosing interval. RESULTS We included 6284 test-positive cases and 8389 test-negative controls. VE against symptomatic infection declined from 24% (95% confidence interval [CI], 8% to 36%) 14 to 29 days after a first dose and 66% (95% CI, 60% to 71%) 7 to 29 days after 2 doses. VE was higher for children with dosing intervals of ≥56 days (57% [95% CI, 51% to 62%]) than 15 to 27 days (12% [95% CI, -11% to 30%]) and 28 to 41 days (38% [95% CI, 28% to 47%]), but appeared to wane over time for all dosing interval groups. VE against severe outcomes was 94% (95% CI, 57% to 99%) 7 to 29 days after 2 doses and declined to 57% (95%CI, -20% to 85%) after ≥120 days. CONCLUSIONS In children aged 5 to 11 years, 2 doses of BNT162b2 provide moderate protection against symptomatic Omicron infection within 4 months of vaccination and good protection against severe outcomes. Protection wanes more rapidly for infection than severe outcomes. Overall, longer dosing intervals confer higher protection against symptomatic infection, however protection decreases and becomes similar to shorter dosing interval starting 90 days after vaccination.
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Affiliation(s)
- Pierre-Philippe Piché-Renaud
- Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute for Health, Policy, Management and Evaluation
| | | | - Sarah A Buchan
- Dalla Lana School of Public Health.,Centre for Vaccine Preventable Diseases.,ICES, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Sarah E Wilson
- Dalla Lana School of Public Health.,Centre for Vaccine Preventable Diseases.,ICES, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Peter C Austin
- Institute for Health, Policy, Management and Evaluation.,ICES, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Pediatric Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Dalla Lana School of Public Health.,Centre for Vaccine Preventable Diseases.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Sharifa Nasreen
- Dalla Lana School of Public Health.,ICES, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Dalla Lana School of Public Health.,ICES, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Mina Tadrous
- ICES, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
| | - Nisha Thampi
- Public Health Ontario, Toronto, Ontario, Canada.,Departments of Pediatrics
| | - Kumanan Wilson
- Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyere Hospital Research Institutes, Ottawa, Ontario, Canada; and
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health.,Centre for Vaccine Preventable Diseases.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
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24
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Posen HJ, Wong W, Farrar DS, Campigotto A, Chan T, Barker KR, Hagmann SHF, Ryan ET, LaRocque RC, Earl AM, Worby CJ, Castelli F, Fumadó VP, Britton PN, Libman M, Hamer DH, Morris SK. Travel-associated extensively drug-resistant typhoid fever: a case series to inform management in non-endemic regions. J Travel Med 2023; 30:6651791. [PMID: 35904457 DOI: 10.1093/jtm/taac086] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/29/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Extensively drug-resistant (XDR) typhoid fever is a threat to travelers to Pakistan. We describe a multicontinental case series of travel-acquired XDR typhoid fever to demonstrate the global spread of the problem and encourage preventive interventions as well as appropriate empiric antimicrobial use. METHODS Cases were extracted from the GeoSentinel database, microbiologic laboratory records of two large hospitals in Toronto, Canada, and by invitation to TropNet sites. All isolates were confirmed XDR Salmonella enterica serovar Typhi (Salmonella typhi), with resistance to ampicillin, ceftriaxone, ciprofloxacin and trimethoprim-sulfamethoxazole. RESULTS Seventeen cases were identified in Canada (10), USA (2), Spain (2), Italy (1), Australia (1) and Norway (1). Patients under 18 years represented 71% (12/17) of cases, and all patients travelled to Pakistan to visit friends or relatives. Only one patient is known to have been vaccinated. Predominant symptoms were fever, abdominal pain, vomiting and diarrhoea. Antimicrobial therapy was started on Day 1 of presentation in 75% (12/16) of patients, and transition to a carbapenem or azithromycin occurred a median of 2 days after blood culture was drawn. Antimicrobial susceptibilities were consistent with the XDR S. typhi phenotype, and whole genome sequencing on three isolates confirmed their belonging to the XDR variant of the H58 clade. CONCLUSIONS XDR typhoid fever is a particular risk for travelers to Pakistan, and empiric use of a carbapenem or azithromycin should be considered. Pre-travel typhoid vaccination and counseling are necessary and urgent interventions, especially for visiting friends and relatives travelers. Ongoing sentinel surveillance of XDR typhoid fever is needed to understand changing epidemiology.
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Affiliation(s)
- H Joshua Posen
- Department of Paediatrics, Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
| | - Waison Wong
- Department of Paediatric Infectious Diseases and Immunology, Alder Hey Children's Hospital, Liverpool, UK
| | - Daniel S Farrar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Aaron Campigotto
- Department of Paediatric Laboratory Medicine, Division of Microbiology, Hospital for Sick Children, Toronto, ON, Canada
| | - Tiffany Chan
- Division of Infectious Diseases, Trillium Health Partners, Mississauga, ON, Canada
| | - Kevin R Barker
- Division of Microbiology, Department of Laboratory Medicine and Genetics, Trillium Health Partners, Mississauga, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stefan H F Hagmann
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center/Northwell Health, New Hyde Park, NY, USA
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine/Hofstra Northwell, New Hempstead, NY, USA
| | - Edward T Ryan
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Regina C LaRocque
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ashlee M Earl
- Infectious Disease and Microbiome Program, Broad Institute (Cambridge Massachusetts), MA, USA
| | - Colin J Worby
- Infectious Disease and Microbiome Program, Broad Institute (Cambridge Massachusetts), MA, USA
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
- ASST Spedali Civili, Brescia, Italy
| | - Victoria Pérez Fumadó
- Infectious Diseases Department, Hospital Universitari Sant Joan de Déu, Barcelona, Spain
| | - Philip N Britton
- Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Quebec
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Center for Emerging Infectious Diseases Research and Policy, Boston University, Boston, MA, USA
| | - Shaun K Morris
- Department of Paediatrics, Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON, Canada
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Harish V, Buajitti E, Burrows H, Posen J, Bogoch II, Corbeil A, Gubbay JB, Rosella LC, Morris SK. Geographic clustering of travel-acquired infections in Ontario, Canada, 2008-2020. PLOS Glob Public Health 2023; 3:e0001608. [PMID: 36963058 PMCID: PMC10022755 DOI: 10.1371/journal.pgph.0001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/20/2023] [Indexed: 03/19/2023]
Abstract
As the frequency of international travel increases, more individuals are at risk of travel-acquired infections (TAIs). In this ecological study of over 170,000 unique tests from Public Health Ontario's laboratory, we reviewed all laboratory-reported cases of malaria, dengue, chikungunya, and enteric fever in Ontario, Canada between 2008-2020 to identify high-resolution geographical clusters for potential targeted pre-travel prevention. Smoothed standardized incidence ratios (SIRs) and 95% posterior credible intervals (CIs) were estimated using a spatial Bayesian hierarchical model. High- and low-incidence areas were described using data from the 2016 Census based on the home forward sortation area of patients testing positive. A second model was used to estimate the association between drivetime to the nearest travel clinic and incidence of TAI within high-incidence areas. There were 6,114 microbiologically confirmed TAIs across Ontario over the study period. There was spatial clustering of TAIs (Moran's I = 0.59, p<0.0001). Compared to low-incidence areas, high-incidence areas had higher proportions of immigrants (p<0.0001), were lower income (p = 0.0027), had higher levels of university education (p<0.0001), and less knowledge of English/French languages (p<0.0001). In the high-incidence Greater Toronto Area (GTA), each minute increase in drive time to the closest travel clinic was associated with a 3% reduction in TAI incidence (95% CI 1-6%). While urban neighbourhoods in the GTA had the highest burden of TAIs, geographic proximity to a travel clinic in the GTA was not associated with an area-level incidence reduction in TAI. This suggests other barriers to seeking and adhering to pre-travel advice.
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Affiliation(s)
- Vinyas Harish
- MD/PhD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Emmalin Buajitti
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Holly Burrows
- Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | - Joshua Posen
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
| | - Isaac I. Bogoch
- Division of Infectious Diseases, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Jonathan B. Gubbay
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Shaun K. Morris
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- * E-mail:
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Chan NHM, Merali HS, Mistry N, Kealey R, Campbell DM, Morris SK, Data S. Utilization of a novel mobile application, "HBB Prompt", to reduce Helping Babies Breathe skills decay. PLOS Glob Public Health 2023; 3:e0000705. [PMID: 37155596 PMCID: PMC10166562 DOI: 10.1371/journal.pgph.0000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 03/20/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Helping Babies Breathe (HBB) is a newborn resuscitation training program designed to reduce neonatal mortality in low- and middle-income countries. However, skills decay after initial training is a significant barrier to sustained impact. OBJECTIVE To test whether a mobile app, HBB Prompt, developed with user-centred design, helps improve skills and knowledge retention after HBB training. METHODS HBB Prompt was created during Phase 1 of this study with input from HBB facilitators and providers from Southwestern Uganda recruited from a national HBB provider registry. During Phase 2, healthcare workers (HCWs) in two community hospitals received HBB training. One hospital was randomly assigned as the intervention hospital, where trained HCWs had access to HBB Prompt, and the other served as control without HBB Prompt (NCT03577054). Participants were evaluated using the HBB 2.0 knowledge check and Objective Structured Clinical Exam, version B (OSCE B) immediately before and after training, and 6 months post-training. The primary outcome was difference in OSCE B scores immediately after training and 6 months post-training. RESULTS Twenty-nine HCWs were trained in HBB (17 in intervention, 12 in control). At 6 months, 10 HCW were evaluated in intervention and 7 in control. In intervention and control respectively, the median OSCE B scores were: 7 vs. 9 immediately before training, 17 vs. 21 immediately after training, and 12 vs. 13 at 6 months after training. Six months after training, the median difference in OSCE B scores was -3 (IQR -5 to -1) in intervention and -8 (IQR -11 to -6) in control (p = 0.02). CONCLUSION HBB Prompt, a mobile app created by user-centred design, improved retention of HBB skills at 6 months. However, skills decay remained high 6 months after training. Continued adaptation of HBB Prompt may further improve maintenance of HBB skills.
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Affiliation(s)
- Natalie Hoi-Man Chan
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, California, United States of America
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hasan S Merali
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Niraj Mistry
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ryan Kealey
- Interactive Media Lab, University of Toronto, Toronto, Ontario, Canada
- Design Research, TD Bank Group, Toronto, Ontario, Canada
| | - Douglas M Campbell
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Shaun K Morris
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Centre for Global Child Health, and Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Uganda
- Consortium for Affordable Medical Technologies in Uganda (CAMTech Uganda), Mbarara, Uganda
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Piché‐Renaud P, Morris SK, Top KA. A narrative review of vaccine pharmacovigilance during mass vaccination campaigns: Focus on myocarditis and pericarditis after COVID-19 mRNA vaccination. Br J Clin Pharmacol 2022; 89:967-981. [PMID: 36480113 PMCID: PMC9878271 DOI: 10.1111/bcp.15625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
Vaccines have had a tremendous impact on reducing the burden of infectious diseases; however, they have the potential to cause adverse events following immunization (AEFIs). Prelicensure clinical trials are limited in their ability to detect rare AEFIs that may occur in less than one per thousand individuals. While postmarketing surveillance systems have shown COVID-19 mRNA vaccines to be safe, they led to the identification of rare cases of myocarditis and pericarditis after COVID-19 vaccination that were not initially detected in clinical trials. In this narrative review, we highlight concepts of vaccine pharmacovigilance during mass vaccination campaigns and compare the approaches used in the context of myocarditis and pericarditis following COVID-19 vaccination to historical examples. We describe mechanisms of passive and active surveillance, their strengths and limitations, and how they interacted to identify and characterize the safety signal of myocarditis and pericarditis after COVID-19 mRNA vaccination. Articles were synthesized from a PubMed search using relevant keywords for articles published on vaccine surveillance systems and myocarditis and pericarditis after COVID-19 vaccination, as well as the authors' collections of relevant publications and grey literature reports. The global experience around the identification and monitoring of myocarditis and pericarditis after COVID-19 mRNA vaccination has provided important lessons for vaccine safety surveillance and highlighted its importance in maintaining public trust in mass vaccination programmes in a pandemic context.
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Affiliation(s)
| | - Shaun K. Morris
- Division of Infectious DiseasesThe Hospital for Sick ChildrenTorontoOntarioCanada,Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoOntarioCanada,Department of Pediatrics, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada,Clinical Public Health, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Karina A. Top
- Department of PediatricsDalhousie University and Canadian Center for Vaccinology, IWK Health CentreHalifaxNova ScotiaCanada
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28
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Science M, Caldeira-Kulbakas M, Parekh RS, Maguire BR, Carroll S, Anthony SJ, Bitnun A, Bourns LE, Campbell DM, Cohen E, Dodds A, Dubey V, Friedman JN, Greenwood JL, Hopkins JP, Imgrund R, Korczak DJ, Looi T, Louca E, Mertz D, Nashid J, Panzera G, Schneiderman JE, Schwartz KL, Streitenberger L, Vuppal S, Walsh CM, Jüni P, Matava CT, Allen U, Alvares AD, Birken CS, Brown A, Carbone VL, Christie A, Cividino ME, Cohen-Silver JH, Cohn RD, Crosbie J, da Costa BR, Dharmaraj B, Freeman SJ, Gaebe K, Hajjaj O, Huang L, Khan S, Lee E, Logeman C, Manteghi S, Moore C, Morris SK, Orkin J, Pelger SD, Pickel L, Salman S, Shouldice A, Solomon R, Thampi N, Thorpe K, Wasiak A, Xie J. Effect of Wearing a Face Mask on Hand-to-Face Contact by Children in a Simulated School Environment: The Back-to-School COVID-19 Simulation Randomized Clinical Trial. JAMA Pediatr 2022; 176:1169-1175. [PMID: 36279142 PMCID: PMC9593317 DOI: 10.1001/jamapediatrics.2022.3833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE Wearing a face mask in school can reduce SARS-CoV-2 transmission but it may also lead to increased hand-to-face contact, which in turn could increase infection risk through self-inoculation. OBJECTIVE To evaluate the effect of wearing a face mask on hand-to-face contact by children while at school. DESIGN, SETTING, AND PARTICIPANTS This prospective randomized clinical trial randomized students from junior kindergarten to grade 12 at 2 schools in Toronto, Ontario, Canada, during August 2020 in a 1:1 ratio to either a mask or control class during a 2-day school simulation. Classes were video recorded from 4 angles to accurately capture outcomes. INTERVENTIONS Participants in the mask arm were instructed to bring their own mask and wear it at all times. Students assigned to control classes were not required to mask at any time (grade 4 and lower) or in the classroom where physical distancing could be maintained (grade 5 and up). MAIN OUTCOMES AND MEASURES The primary outcome was the number of hand-to-face contacts per student per hour on day 2 of the simulation. Secondary outcomes included hand-to-mucosa contacts and hand-to-nonmucosa contacts. A mixed Poisson regression model was used to derive rate ratios (RRs), adjusted for age and sex with a random intercept for class with bootstrapped 95% CIs. RESULTS A total of 174 students underwent randomization and 171 students (mask group, 50.6% male; control group, 52.4% male) attended school on day 2. The rate of hand-to-face contacts did not differ significantly between the mask and the control groups (88.2 vs 88.7 events per student per hour; RR, 1.00; 95% CI, 0.78-1.28; P = >.99). When compared with the control group, the rate of hand-to-mucosa contacts was significantly lower in the mask group (RR, 0.12; 95% CI, 0.07-0.21), while the rate of hand-to-nonmucosa contacts was higher (RR, 1.40; 95% CI, 1.08-1.82). CONCLUSIONS AND RELEVANCE In this clinical trial of simulated school attendance, hand-to-face contacts did not differ among students required to wear face masks vs students not required to wear face masks; however, hand-to-mucosa contracts were lower in the face mask group. This suggests that mask wearing is unlikely to increase infection risk through self-inoculation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04531254.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Monica Caldeira-Kulbakas
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rulan S. Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bryan R. Maguire
- Biostatistics Design and Analysis Unit, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacie Carroll
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Samantha J. Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Douglas M. Campbell
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Neonatal Intensive Care Unit, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada,Allan Waters Family Simulation Program, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Complex Care Program, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Alison Dodds
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vinita Dubey
- Communicable Disease Control, Toronto Public Health, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy N. Friedman
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jodi L. Greenwood
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Jessica P. Hopkins
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ryan Imgrund
- Biostatistics, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Daphne J. Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Looi
- Department of Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada,The Wilfred and Joyce Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emily Louca
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dominik Mertz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada,Department of Infection Prevention and Control, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John Nashid
- Corporate Strategy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giovanna Panzera
- Child and Family Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada,Education and Community Partnership Program, Toronto District School Board, Toronto, Ontario, Canada
| | - Jane E. Schneiderman
- Division of Respiratory Medicine, Clinical Research Services, The Hospital for Sick Children, Toronto, Ontario, Canada,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Kevin L. Schwartz
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Division of Infectious Diseases, Department of Medicine, Unity Health Toronto, Toronto, Ontario, Canada
| | - Laurie Streitenberger
- Infection Prevention & Control (IPAC) Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunayna Vuppal
- SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catharine M. Walsh
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,SimKids Simulation Program, The Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Jüni
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clyde T. Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Upton Allen
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Ahuva Brown
- for the Back-to-School COVID-19 School Study Group
| | | | | | | | | | | | | | | | | | | | | | - Omar Hajjaj
- for the Back-to-School COVID-19 School Study Group
| | - Lennox Huang
- for the Back-to-School COVID-19 School Study Group
| | - Sarah Khan
- for the Back-to-School COVID-19 School Study Group
| | - Eon Lee
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Clara Moore
- for the Back-to-School COVID-19 School Study Group
| | | | - Julia Orkin
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Soha Salman
- for the Back-to-School COVID-19 School Study Group
| | | | | | - Nisha Thampi
- for the Back-to-School COVID-19 School Study Group
| | - Kevin Thorpe
- for the Back-to-School COVID-19 School Study Group
| | - Anna Wasiak
- for the Back-to-School COVID-19 School Study Group
| | - Jiayin Xie
- for the Back-to-School COVID-19 School Study Group
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Farrar DS, Drouin O, Moore Hepburn C, Baerg K, Chan K, Cyr C, Donner EJ, Embree JE, Farrell C, Forgie S, Giroux R, Kang KT, King M, Laffin Thibodeau M, Orkin J, Ouldali N, Papenburg J, Pound CM, Price VE, Proulx-Gauthier JP, Purewal R, Ricci C, Sadarangani M, Salvadori MI, Thibeault R, Top KA, Viel-Thériault I, Kakkar F, Morris SK. Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020–May 2021. The Lancet Regional Health - Americas 2022; 15:100337. [PMID: 35936225 PMCID: PMC9342862 DOI: 10.1016/j.lana.2022.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Muñoz CE, MacDonald B, Pham-Huy A, Vaudry W, Pernica JM, Boucher FD, Constantinescu C, Sadarangani M, Bettinger JA, Tapiéro B, Morris SK, McConnell A, Cowan J, Zafack J, Upton J, Abdurrahman Z, McHenry M, Hildebrand KJ, Noya F, De Serres G, Halperin SA, Top KA. Revaccination and Adverse Event Recurrence in Patients with Adverse Events following Immunization. J Pediatr 2022; 250:45-53.e3. [PMID: 35948192 DOI: 10.1016/j.jpeds.2022.07.019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To estimate the risk of recurrence of adverse events following immunization (AEFIs) upon revaccination and to determine among patients with suspected vaccine allergy whether allergy skin test positivity was associated with AEFI recurrence. STUDY DESIGN This prospective observational study included patients assessed in the Canadian Special Immunization Clinic Network from 2013 to 2019 with AEFIs who required revaccination with the vaccine temporally associated with their AEFI. Participants underwent standardized assessment and data collection. Special Immunization Clinic physicians used guidelines to inform their recommendations. Participants were followed up after revaccination to capture AEFI recurrences. Data were transferred to a central database for descriptive analysis. RESULTS Overall, 588 participants were assessed for 627 AEFIs; 570 (91%) AEFIs occurred in children <18 years of age. AEFIs included immediate hypersensitivity (130/627; 21%), large local reactions (110/627; 18%), nonurticarial rash (51/627; 8%), seizures (26/627; 4%), and thrombocytopenia (11/627; 2%). Revaccination was recommended to 513 of 588 (87%) participants. Among participants recommended and due for revaccination during the study period, 63% (299/477) were revaccinated. AEFI recurrence was 10% (31/299) overall, 31% (15/49) for large local reactions, and 7% (5/66) for immediate hypersensitivity. No recurrence was serious. Among 92 participants with suspected vaccine allergy who underwent skin testing and were revaccinated, the negative predictive value of skin testing for AEFI recurrence was 96% (95% CI 92.5%-99.5%). CONCLUSIONS Most individuals with AEFIs were safely revaccinated. Among those with suspected vaccine allergy, skin testing may help determine the safety of revaccination.
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Affiliation(s)
- Caroline E Muñoz
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada; Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Beth MacDonald
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada; Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne Pham-Huy
- Division of Infectious Diseases, Immunology and Allergy, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Wendy Vaudry
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey M Pernica
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - François D Boucher
- Centre hospitalier universitaire de Québec-Université Laval, Québec, Canada
| | - Cora Constantinescu
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Pediatrics, Faculty of Medicine, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Department of Pediatrics, Faculty of Medicine, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Bruce Tapiéro
- Division of Infectious Diseases, CHU Sainte Justine, Université de Montréal, Montréal, Québec, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children & Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Athena McConnell
- Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juthaporn Cowan
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Julia Upton
- Division of Infectious Diseases, Hospital for Sick Children & Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zainab Abdurrahman
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mary McHenry
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kyla J Hildebrand
- Department of Pediatrics, Faculty of Medicine, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Francisco Noya
- Division of Allergy and Immunology and Division of Infectious Diseases, Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada
| | - Gaston De Serres
- Centre hospitalier universitaire de Québec-Université Laval, Québec, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karina A Top
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada; Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
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Choi BCK, King AS, Graham K, Bilotta R, Selby P, Harvey BJ, Gupta N, Morris SK, Young E, Buklis P, Reynolds DL, Rachlis B, Upshur R. Clinical public health: harnessing the best of both worlds in sickness and in health. Health Promot Chronic Dis Prev Can 2022; 42:440-444. [PMID: 36223159 PMCID: PMC9584176 DOI: 10.24095/hpcdp.42.10.03] [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] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Effective, sustained collaboration between clinical and public health professionals can lead to improved individual and population health. The concept of clinical public health promotes collaboration between clinical medicine and public health to address complex, real-world health challenges. In this commentary, we describe the concept of clinical public health, the types of complex problems that require collaboration between individual and population health, and the barriers towards and applications of clinical public health that have become evident during the COVID-19 pandemic. RATIONALE The focus of clinical medicine on the health of individuals and the aims of public health to promote and protect the health of populations are complementary. Interdisciplinary collaborations at both levels of health interventions are needed to address complex health problems. However, there is a need to address the disciplinary, cultural and financial barriers to achieving greater and sustained collaboration. Recent successes, particularly during the COVID-19 pandemic, provide a model for such collaboration between clinicians and public health practitioners. CONCLUSION A public health approach that fosters ongoing collaboration between clinical and public health professionals in the face of complex health threats will have greater impact than the sum of the parts.
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Affiliation(s)
- Bernard C K Choi
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Arlene S King
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn Graham
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto/London, Ontario, Canada
| | - Rose Bilotta
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto/London, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bart J Harvey
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Neeru Gupta
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Young
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Pierrette Buklis
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Donna L Reynolds
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Beth Rachlis
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
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32
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Tehseen S, Williams S, Robinson J, Morris SK, Bitnun A, Gill P, Tal TE, Yeh A, Yea C, Ulloa‐Gutierrez R, Brenes‐Chacon H, Yock‐Corrales A, Ivankovich‐Escoto G, Soriano‐Fallas A, Papenburg J, Lefebvre M, Scuccimarri R, Nateghian A, Aski BH, Dwilow R, Bullard J, Cooke S, Restivo L, Lopez A, Sadarangani M, Roberts A, Forbes M, Saux NL, Bowes J, Purewal R, Lautermilch J, Bayliss A, Wong JK, Leifso K, Foo C, Panetta L, Kakkar F, Piche D, Viel‐Theriault I, Merckx J, Lieberman L. Thrombosis and hemorrhage experienced by hospitalized children with SARS-CoV-2 infection or MIS-C: Results of the PICNIC registry. Pediatr Blood Cancer 2022; 69:e29793. [PMID: 35689507 PMCID: PMC9350140 DOI: 10.1002/pbc.29793] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Coagulopathy and thrombosis associated with SARS-CoV-2 infection are well defined in hospitalized adults and leads to adverse outcomes. Pediatric studies are limited. METHODS An international multicentered (n = 15) retrospective registry collected information on the clinical manifestations of SARS-CoV-2 and multisystem inflammatory syndrome (MIS-C) in hospitalized children from February 1, 2020 through May 31, 2021. This sub-study focused on coagulopathy. Study variables included patient demographics, comorbidities, clinical presentation, hospital course, laboratory parameters, management, and outcomes. RESULTS Nine hundred eighty-five children were enrolled, of which 915 (93%) had clinical information available; 385 (42%) had symptomatic SARS-CoV-2 infection, 288 had MIS-C (31.4%), and 242 (26.4%) had SARS-CoV-2 identified incidentally. Ten children (1%) experienced thrombosis, 16 (1.7%) experienced hemorrhage, and two (0.2%) experienced both thrombosis and hemorrhage. Significantly prevalent prothrombotic comorbidities included congenital heart disease (p-value .007), respiratory support (p-value .006), central venous catheter (CVC) (p = .04) in children with primary SARS-CoV-2 and in those with MIS-C included respiratory support (p-value .03), obesity (p-value .002), and cytokine storm (p = .012). Comorbidities prevalent in children with hemorrhage included age >10 years (p = .04), CVC (p = .03) in children with primary SARS-CoV-2 infection and in those with MIS-C encompassed thrombocytopenia (p = .001) and cytokine storm (p = .02). Eleven patients died (1.2%), with no deaths attributed to thrombosis or hemorrhage. CONCLUSION Thrombosis and hemorrhage are uncommon events in children with SARS-CoV-2; largely experienced by those with pre-existing comorbidities. Understanding the complete spectrum of coagulopathy in children with SARS-CoV-2 infection requires ongoing research.
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Affiliation(s)
- Sarah Tehseen
- Department of Laboratory medicine and PediatricsUniversity of Saskatchewan, SHASaskatoonSaskatchewanCanada
| | - Suzan Williams
- Division of Hematology OncologyHospital for Sick ChildrenTorontoOntarioCanada
| | - Joan Robinson
- Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Shaun K. Morris
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Ari Bitnun
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Peter Gill
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Tala El Tal
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Ann Yeh
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Carmen Yea
- Department of Pediatrics, Division of Infectious DiseasesUniversity of TorontoTorontoOntarioCanada
| | - Rolando Ulloa‐Gutierrez
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Helena Brenes‐Chacon
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Adriana Yock‐Corrales
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Gabriela Ivankovich‐Escoto
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Alejandra Soriano‐Fallas
- Department of PediatricsHospital Nacional de Niños “Dr. Carlos Sáenz Herrera,” Caja Costarricense de Seguro Social (CCSS)San JoséCosta Rica
| | - Jesse Papenburg
- Department of PediatricsMcGill UniversityMontrealQuebecCanada
| | | | | | - Alireza Nateghian
- Department of PediatricsIran University of Medical SciencesTehranIran
| | | | - Rachel Dwilow
- Department of PediatricsUniversity of ManitobaWinnipegManitobaCanada
| | - Jared Bullard
- Department of PediatricsUniversity of ManitobaWinnipegManitobaCanada
| | - Suzette Cooke
- Department of PediatricsUniversity of CalgaryCalgaryAlbertaCanada
| | - Lea Restivo
- Department of PediatricsUniversity of CalgaryCalgaryAlbertaCanada
| | - Alison Lopez
- Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Manish Sadarangani
- Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Vaccine Evaluation CenterBC Children's Hospital Research InstituteVancouverBritish ColumbiaCanada
| | - Ashley Roberts
- Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Michelle Forbes
- Department of PediatricsWestern UniversityLondonOntarioCanada
| | - Nicole Le Saux
- Department of PediatricsUniversity of OttawaOttawaOntarioCanada
| | - Jennifer Bowes
- Department of PediatricsUniversity of OttawaOttawaOntarioCanada
| | - Rupeena Purewal
- Department of PediatricsUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Janell Lautermilch
- Department of PediatricsUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Ann Bayliss
- Department of PediatricsTrillium Health PartnersMississaugaOntarioCanada
| | | | - Kirk Leifso
- Department of PediatricsQueen's UniversityKingstonOntarioCanada
| | - Cheryl Foo
- Department of PediatricsMemorial UniversitySt John'sNewfoundland and LabradorCanada
| | - Luc Panetta
- Department of PediatricsUniversitie du MontrealMontrealQuebecCanada
| | - Fatima Kakkar
- Department of PediatricsUniversitie du MontrealMontrealQuebecCanada
| | - Dominique Piche
- Department of PediatricsDalhousie UniversityHalifaxNova ScotiaCanada
| | | | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Lani Lieberman
- Department of Laboratory Medicine and PathobiologyUniversity Health NetworkTorontoOntarioCanada
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Robinson J, Dewan T, Morris SK, Bitnun A, Gill P, Tal TE, Laxer RM, Yeh EA, Yea C, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Mezerville MHD, Papenburg J, Lefebvre MA, Nateghian A, Aski BH, Manafi A, Dwilow R, Bullard J, Cooke S, Restivo L, Lopez A, Sadarangani M, Roberts A, Le Saux N, Bowes J, Purewal R, Lautermilch J, Wong JK, Piche D, Top KA, Foo C, Panetta L, Merckx J, Barton M. SARS-CoV-2 infection in technology-dependent children: a multicenter case series. Infection 2022; 51:737-741. [PMID: 36038707 PMCID: PMC9423690 DOI: 10.1007/s15010-022-01910-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/16/2022] [Indexed: 11/27/2022]
Abstract
Purpose The objective of this study was to describe the clinical course and outcomes in children with technology dependence (TD) hospitalized with SARS-CoV-2 infection. Methods Seventeen pediatric hospitals (15 Canadian and one each in Iran and Costa Rica) included children up to 17 years of age admitted February 1, 2020, through May 31, 2021, with detection of SARS-CoV-2. For those with TD, data were collected on demographics, clinical course and outcome. Results Of 691 children entered in the database, 42 (6%) had TD of which 22 had feeding tube dependence only, 9 were on supplemental oxygen only, 3 had feeding tube dependence and were on supplemental oxygen, 2 had a tracheostomy but were not ventilated, 4 were on non-invasive ventilation, and 2 were on mechanical ventilation prior to admission. Three of 42 had incidental SARS-CoV-2 infection. Two with end-stage underlying conditions were transitioned to comfort care and died. Sixteen (43%) of the remaining 37 cases required increased respiratory support from baseline due to COVID-19 while 21 (57%) did not. All survivors were discharged home. Conclusion Children with TD appear to have an increased risk of COVID-19 hospitalization. However, in the absence of end-stage chronic conditions, all survived to discharge.
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Affiliation(s)
- Joan Robinson
- Department of Pediatrics, University of Alberta, 3-556ECHA, Edmonton, AB, T6G 1C9, Canada.
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Shaun K Morris
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Ronald M Laxer
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Marcela Hernandez-de Mezerville
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Jesse Papenburg
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | | | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Alison Lopez
- British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Manish Sadarangani
- British Columbia Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ashley Roberts
- British Columbia Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Dominique Piche
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University, St John's, NL, Canada
| | - Luc Panetta
- Department of Pediatrics, Universite de Montreal, Montreal, QC, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, ON, Canada
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34
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Schober T, Caya C, Barton M, Bayliss A, Bitnun A, Bowes J, Brenes-Chacon H, Bullard J, Cooke S, Dewan T, Dwilow R, El Tal T, Foo C, Gill P, Haghighi Aski B, Kakkar F, Lautermilch J, Lefebvre MA, Leifso K, Le Saux N, Lopez A, Manafi A, Merckx J, Morris SK, Nateghian A, Panetta L, Petel D, Piché D, Purewal R, Restivo L, Roberts A, Sadarangani M, Scuccimarri R, Soriano-Fallas A, Tehseen S, Top KA, Ulloa-Gutierrez R, Viel-Theriault I, Wong J, Yea C, Yeh A, Yock-Corrales A, Robinson JL, Papenburg J. Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001440. [PMID: 36053578 PMCID: PMC9358955 DOI: 10.1136/bmjpo-2022-001440] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/19/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection. DESIGN Multicentre retrospective cohort study. SETTING 18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021. PATIENTS Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C). MAIN OUTCOME MEASURE Severity on the WHO COVID-19 Clinical Progression Scale was used for ordinal logistic regression analyses. RESULTS We identified 403 hospitalisations. Median age was 3.78 years (IQR 0.53-10.77). At least one comorbidity was present in 46.4% (187/403) and multiple comorbidities in 18.6% (75/403). Eighty-one children (20.1%) met WHO criteria for PCR-positive MIS-C. Progression to WHO clinical scale score ≥6 occurred in 25.3% (102/403). In multivariable ordinal logistic regression analyses adjusted for age, chest imaging findings, laboratory-confirmed bacterial and/or viral coinfection, and MIS-C diagnosis, presence of a single (adjusted OR (aOR) 1.90, 95% CI 1.13 to 3.20) or multiple chronic comorbidities (aOR 2.12, 95% CI 1.19 to 3.79), obesity (aOR 3.42, 95% CI 1.76 to 6.66) and chromosomal disorders (aOR 4.47, 95% CI 1.25 to 16.01) were independent risk factors for severity. Age was not an independent risk factor, but different age-specific comorbidities were associated with more severe disease in age-stratified adjusted analyses: cardiac (aOR 2.90, 95% CI 1.11 to 7.56) and non-asthma pulmonary disorders (aOR 3.07, 95% CI 1.26 to 7.49) in children<12 years old and obesity (aOR 3.69, 1.45-9.40) in adolescents≥12 years old. Among infants<1 year old, neurological (aOR 10.72, 95% CI 1.01 to 113.35) and cardiac disorders (aOR 10.13, 95% CI 1.69 to 60.54) were independent predictors of severe disease. CONCLUSION We identified risk factors for disease severity among children hospitalised for PCR-positive SARS-CoV-2 infection. Comorbidities predisposing children to more severe disease may vary by age. These findings can potentially guide vaccination programmes and treatment approaches in children.
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Affiliation(s)
- Tilmann Schober
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Chelsea Caya
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Ann Bayliss
- Department of Pediatrics, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Behzad Haghighi Aski
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Fatima Kakkar
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Kirk Leifso
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Lopez
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Ali Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Shaun K Morris
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Luc Panetta
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Dara Petel
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Dominique Piché
- Department of Pediatrics, Dalhousie University, Halifax, British Columbia, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Ashley Roberts
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.,Vaccine Evaluation Center, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Rosie Scuccimarri
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Sarah Tehseen
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, British Columbia, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | | | - Jacqueline Wong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jesse Papenburg
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada .,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Diamond L, Wine R, Morris SK. Impact of intrapartum antibiotics on the infant gastrointestinal microbiome: a narrative review. Arch Dis Child 2022; 107:627-634. [PMID: 34716171 DOI: 10.1136/archdischild-2021-322590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/14/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The composition of the infant gastrointestinal (GI) microbiome has been linked to adverse long-term health outcomes and neonatal sepsis. Several factors are known to impact the composition of the microbiome, including mode of delivery, gestational age, feeding method and exposure to antibiotics. The impact of intrapartum antibiotics (IPAs) on the infant microbiome requires further research. OBJECTIVE We aimed to evaluate the impact of IPAs on the infant GI microbiome. METHODS We searched Ovid MEDLINE and Embase Classic+Embase for articles in English reporting on the microbiome of infants exposed to IPAs from the date of inception to 3 January 2021. Primary outcomes included abundance and colonisation of Bifidobacterium and Lactobacillus, as well as alpha and beta diversity. RESULTS 30 papers were included in this review. In the first year of life, following exposure to IPAs, 30% (6/20) of infant cohorts displayed significantly reduced Bifidobacterium, 89% (17/19) did not display any significant differences in Lactobacillus colonisation, 21% (7/34) displayed significantly reduced alpha diversity and 35% (12/34) displayed alterations in beta diversity. Results were further stratified by delivery, gestational age (preterm or full term) and feeding method. CONCLUSIONS IPAs impact the composition of the infant GI microbiome, resulting in possible reductions Bifidobacterium and alpha diversity, and possible alterations in beta diversity. Our findings may have implications for maternal and neonatal health, including interventions to prevent reductions in health-promoting bacteria (eg, probiotics) and IPA class selection.
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Affiliation(s)
- Laura Diamond
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Wine
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Infectious Diseases and Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada .,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Nasreen S, Wang J, Sadarangani M, Kwong JC, Quach C, Crowcroft NS, Wilson SE, McGeer A, Morris SK, Kellner JD, Sander B, Kus JV, Hoang L, Marra F, Fadel SA. Estimating population-based incidence of community-acquired pneumonia and acute otitis media in children and adults in Ontario and British Columbia using health administrative data, 2005-2018: a Canadian Immunisation Research Network (CIRN) study. BMJ Open Respir Res 2022; 9:9/1/e001218. [PMID: 35764362 PMCID: PMC9240885 DOI: 10.1136/bmjresp-2022-001218] [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] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background There is a paucity of data on the burden of the full spectrum of community-acquired pneumonia (CAP) and acute otitis media (AOM) from outpatient and inpatient settings across the age spectrum. Methods We conducted a population-based retrospective study in Ontario and British Columbia (BC), Canada, to estimate the incidence rate of CAP and AOM in children and adults over a 14-year period using health administrative databases. CAP and AOM cases were identified from outpatient physician consultation and hospitalisation data in both provinces, and from emergency department visit data in Ontario. Results During 2005–2018, Ontario had 3 607 124 CAP, 172 290 bacterial CAP, 7814 pneumococcal pneumonia, and 8 026 971 AOM cases. The incidence rate of CAP declined from 3077/100 000 in 2005 to 2604/100 000 in 2010 before increasing to 2843/100 000 in 2018; bacterial CAP incidence rate also declined from 178/100 000 in 2005 to 112/100 000 in 2010 before increasing to 149/100 000 in 2018. The incidence rate of AOM decreased from 4192/100 000 in 2005 to 3178/100 000 in 2018. BC had 970 455 CAP, 317 913 bacterial CAP, 35 287 pneumococcal pneumonia and 2 022 871 AOM cases. The incidence rate of CAP in BC decreased from 2214/100 000 in 2005 to 1964/100 000 in 2010 before increasing to 2176/100 000 in 2018; bacterial CAP incidence rate increased from 442/100 000 in 2005 to 981/100 000 in 2018. The incidence rate of AOM decreased from 3684/100 000 in 2005 to 2398/100 000 in 2018. The incidence rate of bacterial CAP increased with age in older adults (≥65 years) with the highest burden in the oldest cohort aged ≥85 years both before and after 13-valent pneumococcal conjugate vaccine (PCV13) programme in both provinces. Hospitalised pneumococcal pneumonia decreased slightly but non-hospitalised pneumococcal pneumonia increased in BC during PCV13 period. No consistent direct benefit of PCV13 on CAP was observed in the paediatric population. Conclusions There is a substantial burden of CAP and AOM in Ontario and BC. Indirect benefits from childhood PCV vaccination and polysaccharide vaccination of older adults have not substantially decreased the burden of pneumococcal pneumonia in older adults.
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Affiliation(s)
- Sharifa Nasreen
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jun Wang
- Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Manish Sadarangani
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada,Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey C Kwong
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada,University Health Network, Toronto, Ontario, Canada
| | - Caroline Quach
- Departments of Microbiology, Infectious Diseases & Immunology and Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Natasha S Crowcroft
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E Wilson
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Allison McGeer
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Sinai Health System, Toronto, Ontario, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - James D Kellner
- Department of Paediatrics, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Beate Sander
- Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Julianne V Kus
- Public Health Ontario, Toronto, Ontario, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Linda Hoang
- BC Centre for Disease Control, Vancouver, British Columbia, Canada,Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaza A Fadel
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Berry I, Rahman M, Flora MS, Shirin T, Alamgir ASM, Khan MH, Anwar R, Lisa M, Chowdhury F, Islam MA, Osmani MG, Dunkle S, Brum E, Greer AL, Morris SK, Mangtani P, Fisman DN. Seasonality of influenza and coseasonality with avian influenza in Bangladesh, 2010–19: a retrospective, time-series analysis. Lancet Glob Health 2022; 10:e1150-e1158. [DOI: 10.1016/s2214-109x(22)00212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/22/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
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Merckx J, Cooke S, El Tal T, Bitnun A, Morris SK, Yeh EA, Yea C, Gill P, Papenburg J, Lefebvre MA, Scuccimarri R, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Mezerville MHD, Dewan T, Restivo L, Nateghian A, Aski BH, Manafi A, Dwilow R, Bullard J, Lopez A, Sadarangani M, Roberts A, Barton M, Petel D, Le Saux N, Bowes J, Purewal R, Lautermilch J, Tehseen S, Bayliss A, Wong JK, Leifso K, Foo C, Robinson J. Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study. CMAJ 2022; 194:E513-E523. [PMID: 35410860 PMCID: PMC9001008 DOI: 10.1503/cmaj.210873] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND SARS-CoV-2 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We sought to investigate risk factors for admission to the intensive care unit (ICU) and explored changes in disease severity over time. METHODS We obtained data from chart reviews of children younger than 18 years with confirmed or probable MIS-C who were admitted to 15 hospitals in Canada, Iran and Costa Rica between Mar. 1, 2020, and Mar. 7, 2021. Using multivariable analyses, we evaluated whether admission date and other characteristics were associated with ICU admission or cardiac involvement. RESULTS Of 232 children with MIS-C (median age 5.8 yr), 130 (56.0%) were male and 50 (21.6%) had comorbidities. Seventy-three (31.5%) patients were admitted to the ICU but none died. We observed an increased risk of ICU admission among children aged 13-17 years (adjusted risk difference 27.7%, 95% confidence interval [CI] 8.3% to 47.2%), those aged 6-12 years (adjusted risk difference 25.2%, 95% CI 13.6% to 36.9%) or those with initial ferritin levels greater than 500 μg/L (adjusted risk difference 18.4%, 95% CI 5.6% to 31.3%). Children admitted to hospital after Oct. 31, 2020, had numerically higher rates of ICU admission (adjusted risk difference 12.3%, 95% CI -0.3% to 25.0%) and significantly higher rates of cardiac involvement (adjusted risk difference 30.9%, 95% CI 17.3% to 44.4%). At Canadian sites, the risk of ICU admission was significantly higher for children admitted to hospital between December 2020 and March 2021 than those admitted between March and May 2020 (adjusted risk difference 25.3%, 95% CI 6.5% to 44.0%). INTERPRETATION We observed that age and higher ferritin levels were associated with more severe MIS-C. We observed greater severity of MIS-C later in the study period. Whether emerging SARS-CoV-2 variants pose different risks of severe MIS-C needs to be determined.
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Affiliation(s)
- Joanna Merckx
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Suzette Cooke
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Tala El Tal
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ari Bitnun
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Shaun K Morris
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - E Ann Yeh
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Carmen Yea
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Peter Gill
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jesse Papenburg
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Marie-Astrid Lefebvre
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rosie Scuccimarri
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rolando Ulloa-Gutierrez
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Helena Brenes-Chacon
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Adriana Yock-Corrales
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Gabriela Ivankovich-Escoto
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Alejandra Soriano-Fallas
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Marcela Hernandez-de Mezerville
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Tammie Dewan
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Lea Restivo
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Alireza Nateghian
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Behzad Haghighi Aski
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ali Manafi
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rachel Dwilow
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jared Bullard
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Alison Lopez
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Manish Sadarangani
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ashley Roberts
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Michelle Barton
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Dara Petel
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Nicole Le Saux
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jennifer Bowes
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rupeena Purewal
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Janell Lautermilch
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Sarah Tehseen
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ann Bayliss
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jacqueline K Wong
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Kirk Leifso
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Cheryl Foo
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Joan Robinson
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta.
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Murad Y, Hung TY, Sadarangani M, Morris SK, Le Saux N, Vanderkooi OG, Kellner JD, Tyrrell GJ, Martin I, Demczuk W, Halperin SA, Bettinger JA. Clinical Presentations and Outcomes of Children in Canada With Recurrent Invasive Pneumococcal Disease From the IMPACT Surveillance Network. Pediatr Infect Dis J 2022; 41:e166-e171. [PMID: 35093996 PMCID: PMC8920017 DOI: 10.1097/inf.0000000000003454] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Invasive pneumococcal disease due to Streptococcus pneumoniae can cause mortality and severe morbidity due to sepsis, meningitis and pneumonia, particularly in young children and the elderly. Recurrent invasive pneumococcal disease is rare yet serious sequelae of invasive pneumococcal disease that is associated with the immunocompromised and leads to a high mortality rate. METHOD This retrospective study reviewed recurrent invasive pneumococcal disease cases from the Canadian Immunization Monitoring Program, ACTive (IMPACT) between 1991 and 2019, an active network for surveillance of vaccine-preventable diseases and adverse events following immunization for children ages 0-16 years. Data were collected from 12 pediatric tertiary care hospitals across all 3 eras of public pneumococcal conjugate vaccine implementation in Canada. RESULTS The survival rate within our cohort of 180 recurrent invasive pneumococcal disease cases was 98.3%. A decrease of 26.4% in recurrent invasive pneumococcal disease due to vaccine serotypes was observed with pneumococcal vaccine introduction. There was also a 69.0% increase in the rate of vaccination in children with preexisting medical conditions compared with their healthy peers. CONCLUSION The decrease in recurrent invasive pneumococcal disease due to vaccine-covered serotypes has been offset by an increase of non-vaccine serotypes in this sample of Canadian children.
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Affiliation(s)
- Yousif Murad
- From the Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Te-Yu Hung
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
- Royal Darwin Hospital, Top End Health Service, Northern Territory, Australia
- Royal Melbourne Hospital, Doherty Institute for Infection Immunity, Victoria, Australia
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Shaun K. Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Nicole Le Saux
- Children’s Hospital of Eastern Ontario, Paediatric Infectious Disease, Ottawa, ON, Canada
| | - Otto G. Vanderkooi
- Departments of Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - James D. Kellner
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Gregory J. Tyrrell
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
- Alberta Precision Laboratories-Public Health, Edmonton, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Scott A. Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, and Nova Scotia Health, Halifax, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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Ji C, Piché-Renaud PP, Apajee J, Stephenson E, Forte M, Friedman JN, Science M, Zlotkin S, Morris SK, Tu K. Impact of the COVID-19 pandemic on routine immunization coverage in children under 2 years old in Ontario, Canada: A retrospective cohort study. Vaccine 2022; 40:1790-1798. [PMID: 35164987 PMCID: PMC8824235 DOI: 10.1016/j.vaccine.2022.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic has caused a disruption in childhood immunization coverage around the world. This study aimed to determine the change in immunization coverage for children under 2 years old in Ontario, Canada, comparing time periods pre-pandemic to during the first year of the pandemic. METHODS Observational retrospective open cohort study, using primary care electronic medical record data from the University of Toronto Practice-Based Research Network (UTOPIAN) database, from January 2019 to December 2020. Children under 2 years old who had at least 2 visits recorded in UTOPIAN were included. We measured up-to-date (UTD) immunization coverage rates, overall and by type of vaccine (DTaP-IPV-Hib, PCV13, Rota, Men-C-C, MMR, Var), and on-time immunization coverage rates by age milestone (2, 4, 6, 12, 15, 18 months). We compared average coverage rates over 3 periods of time: January 2019-March 2020 (T1); March-July 2020 (T2); and August-December 2020 (T3). RESULTS 12,313 children were included. Overall UTD coverage for all children was 71.0% in T1, dropped by 5.7% (95% CI: -6.2, -5.1) in T2, slightly increased in T3 but remained lower than in T1. MMR vaccine UTD coverage slightly decreased in T2 and T3 by approximately 2%. The largest decreases were seen at ages 15-month and 18-month old, with drops in on-time coverage of 14.7% (95% CI: -18.7, -10.6) and 16.4% (95% CI: -20.0, -12.8) respectively during T2. When stratified by sociodemographic characteristics, no specific subgroup of children was found to have been differentially impacted by the pandemic. CONCLUSION Childhood immunization coverage rates for children under 2 years in Ontario decreased significantly during the early period of the COVID-19 pandemic and only partially recovered during the rest of 2020. Public health and educational interventions for providers and parents are needed to ensure adequate catch-up of delayed/missed immunizations to prevent potential outbreaks of vaccine-preventable diseases.
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Affiliation(s)
- Catherine Ji
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Toronto Western Family Health Team, University Health Network, 440 Bathurst Street, 3rd Floor, Toronto, Ontario M5T 2S6, Canada.
| | - Pierre-Philippe Piché-Renaud
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8
| | - Jemisha Apajee
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada
| | - Ellen Stephenson
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada
| | - Milena Forte
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Mount Sinai Academic Family Health Team, 60 Murray Street, 4th Floor, Toronto, Ontario M5T 3L9, Canada
| | - Jeremy N Friedman
- Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8; Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Michelle Science
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8
| | - Stanley Zlotkin
- Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8; Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Centre for Global Child Health and the SickKids Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, Ontario M5G 0A4, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8; Centre for Global Child Health and the SickKids Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, Ontario M5G 0A4, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Toronto Western Family Health Team, University Health Network, 440 Bathurst Street, 3rd Floor, Toronto, Ontario M5T 2S6, Canada; North York General Hospital, 4001 Leslie Street, Toronto, Ontario M2K 1E1, Canada
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Groves HE, Papenburg J, Mehta K, Bettinger JA, Sadarangani M, Halperin SA, Morris SK. The effect of the COVID-19 pandemic on influenza-related hospitalization, intensive care admission and mortality in children in Canada: A population-based study. Lancet Reg Health Am 2022; 7:100132. [PMID: 35291567 PMCID: PMC8913102 DOI: 10.1016/j.lana.2021.100132] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background The COVID-19 pandemic resulted in unprecedented implementation of wide-ranging public health measures globally. During the pandemic, dramatic decreases in seasonal influenza virus detection have been reported worldwide. Information on the impact on paediatric influenza-related hospitalisations is limited. We describe influenza-related hospitalisation in children in Canada following the onset of the COVID-19 pandemic. Methods Data on influenza-related hospitalisations, intensive care unit (ICU) admissions and in-hospital deaths in children across Canada were obtained from the Canadian Immunisation Monitoring Program, ACTive (IMPACT). This national active surveillance initiative comprises 90% of all tertiary care paediatric beds in Canada. The study period included eleven influenza seasons, from the 2010/2011 season until the 2020/2021 season inclusive. Time series modelling was used to compare the observed to predicted influenza-related hospitalisations following the COVID-19 pandemic. Results Following the COVID-19 pandemic there was a significant decrease in paediatric influenza-related hospitalisations compared to predicted influenza-related hospitalisations for this time period (p < 0•0001). No paediatric influenza-related hospitalisations, ICU admission or deaths were reported for the 2020/2021 influenza season. Conclusions We show complete absence of paediatric influenza infection-related hospitalisation in a Canadian National Surveillance Network during the 2020/2021 influenza season. This significant decrease is likely related in large part to non-pharmacological public health interventions implemented during the COVID-19 pandemic, although the potential role of viral interference is unknown. Funding The Canadian Immunisation Monitoring Program, Active (IMPACT) influenza surveillance is a national surveillance initiative managed by the Canadian Paediatric Society and conducted by the IMPACT network of paediatric investigators on behalf of the Public Health Agency of Canada's Centre for Immunisation and Respiratory Infectious Diseases.
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Affiliation(s)
- Helen E Groves
- Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jesse Papenburg
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Divisions of Infectious Diseases and Medical Microbiology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Kayur Mehta
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Centre, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Centre, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Scott A Halperin
- Canadian Centre for Vaccinology, Halifax, NS, Canada.,Dalhousie University and the IWK Health Centre Dalhousie University, Halifax, NS, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children, Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Wong JK, Nashid N, Pell LG, Lam RE, Louch DM, Science ME, Morris SK. Pretravel plans and discrepant trip experiences among travelers attending a tertiary care centre family travel medicine clinic. PLoS One 2022; 17:e0262075. [PMID: 35113872 PMCID: PMC8812894 DOI: 10.1371/journal.pone.0262075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background International travel can expose travelers to a number of health risks. Pretravel consultation (PC) helps mitigate risk and prepare travelers for health concerns that might arise. The assessment of risk, mitigation strategies, and relevance of pretravel advice is dependent on how closely travelers adhere to their planned travel itinerary and activities. We determined the proportion of returned travelers whose completed travel experiences differed from their stated travel itineraries, and identified discrepancies that significantly altered the traveler’s health risk and would have required alternative counseling during their PC. Methods We conducted a prospective cohort study at the SickKids’ Family Travel Clinic between October 2014 and November 2015. Returned travelers who completed a post-travel survey were included. Pretravel consultation assessments and post-trip surveys were compared to identify discrepant trip experiences. Results A total of 389 travelers presented to the clinic for a PC during the study period and 302 (77.6%) were enrolled. Post-travel surveys were received from 119 (39.4%) participants, representing 101 unique itineraries. The median participant age was 36.3 years (IQR 26.6–47.5) and there were 73 female travelers (61%). Most participants (n = 87,73%) were healthy as well as Canadian born (n = 84, 71%). A quarter of travelers were visiting friends and relatives (VFR) (n = 30, 25.2%). The vast majority of returned travelers (n = 109, 92%) reported discrepant trip experiences involving trip duration, countries visited, accommodations, environmental surroundings and/or activities. Almost two thirds of these individuals (n = 68, 62%) would have required alternative pretravel counseling. We did not identify any demographic or planned trip characteristics that predicted discrepant trip experiences requiring alternative pretravel counseling. Conclusions The majority of travelers reported discrepant trip experiences and the discrepancies often affected health risk. Therefore, clinicians should consider providing broader counselling during the PC as discrepancies from planned travel are common.
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Affiliation(s)
- Jacqueline K. Wong
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
- * E-mail:
| | - Nancy Nashid
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa G. Pell
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ray E. Lam
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Debra M. Louch
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle E. Science
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaun K. Morris
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
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Lee DID, Vanderhout S, Aglipay M, Birken CS, Morris SK, Piché-Renaud PP, Keown-Stoneman CDG, Maguire JL. Delay in childhood vaccinations during the COVID-19 pandemic. Can J Public Health 2022; 113:126-134. [PMID: 35060107 PMCID: PMC8773389 DOI: 10.17269/s41997-021-00601-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES In many jurisdictions, routine medical care was reduced in response to the COVID-19 pandemic. The objective of this study was to determine whether the frequency of on-time routine childhood vaccinations among children age 0-2 years was lower following the COVID-19 declaration of emergency in Ontario, Canada, on March 17, 2020, compared to prior to the pandemic. METHODS We conducted a longitudinal cohort study of healthy children aged 0-2 years participating in the TARGet Kids! primary care research network in Toronto, Canada. A logistic mixed effects regression model was used to determine odds ratios (ORs) for delayed vaccination (> 30 days vs. ≤ 30 days from the recommended date) before and after the COVID-19 declaration of emergency, adjusted for confounding variables. A Cox proportional hazards model was used to explore the relationship between the declaration of emergency and time to vaccination. RESULTS Among 1277 children, the proportion of on-time vaccinations was 81.8% prior to the COVID-19 declaration of emergency and 62.1% after (p < 0.001). The odds of delayed vaccination increased (odds ratio = 3.77, 95% CI: 2.86-4.96), and the hazard of administration of recommended vaccinations decreased after the declaration of emergency (hazard ratio = 0.75, 95% CI: 0.60-0.92). The median vaccination delay time was 5 days (95% CI: 4-5 days) prior to the declaration of emergency and 17 days (95% CI: 12-22 days) after. CONCLUSION The frequency of on-time routine childhood vaccinations was lower during the first wave of the COVID-19 pandemic. Sustained delays in routine vaccinations may lead to an increase in rates of vaccine-preventable diseases.
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Affiliation(s)
- Da In Diane Lee
- Department of Paediatrics, St. Michael's Hospital, 61 Queen Street East, 2nd Floor, Toronto, ON, M5C 2T2, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shelley Vanderhout
- Department of Paediatrics, St. Michael's Hospital, 61 Queen Street East, 2nd Floor, Toronto, ON, M5C 2T2, Canada.,Department of Nutritional Sciences, Medical Sciences Building, University of Toronto, 1 King's College Circle, Room 5253, Toronto, ON, M5S 1A8, Canada
| | - Mary Aglipay
- Department of Paediatrics, St. Michael's Hospital, 61 Queen Street East, 2nd Floor, Toronto, ON, M5C 2T2, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Catherine S Birken
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Nutritional Sciences, Medical Sciences Building, University of Toronto, 1 King's College Circle, Room 5253, Toronto, ON, M5S 1A8, Canada.,Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, ON, Toronto, Canada
| | - Shaun K Morris
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, ON, Toronto, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
| | - Pierre-Philippe Piché-Renaud
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, ON, Toronto, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada
| | - Charles D G Keown-Stoneman
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Jonathon L Maguire
- Department of Paediatrics, St. Michael's Hospital, 61 Queen Street East, 2nd Floor, Toronto, ON, M5C 2T2, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Department of Nutritional Sciences, Medical Sciences Building, University of Toronto, 1 King's College Circle, Room 5253, Toronto, ON, M5S 1A8, Canada. .,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, ON, Toronto, Canada. .,Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
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Muttalib F, Chung K, Pell LG, Ariff S, Soofi S, Morris SK, Sander B. Cost-effectiveness analysis of implementing an integrated neonatal care kit to reduce neonatal infection in rural Pakistan. BMJ Open 2022; 12:e047793. [PMID: 34983750 PMCID: PMC8728405 DOI: 10.1136/bmjopen-2020-047793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of distribution of the integrated neonatal care kit (iNCK) by community health workers from the healthcare payer perspective in Rahimyar Khan, Pakistan. SETTING Rahimyar Khan, Pakistan. PARTICIPANTS N/A. INTERVENTION Cost-utility analysis using a Markov model based on cluster randomised controlled trial (cRCT: NCT02130856) data and a literature review. We compared distribution of the iNCK to pregnant mothers to local standard of care and followed infants over a lifetime horizon. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was incremental net monetary benefit (INMB, at a cost-effectiveness threshold of US$15.50), discounted at 3%. Secondary outcomes were life years, disability-adjusted life years (DALYs) and costs. RESULTS At a cost-effectiveness threshold of US$15.50, distribution of the iNCK resulted in lower expected DALYs (28.7 vs 29.6 years) at lower expected cost (US$52.50 vs 55.20), translating to an INMB of US$10.22 per iNCK distributed. These results were sensitive to the baseline risk of infection, cost of the iNCK and the estimated effect of the iNCK on the relative risk of infection. At relative risks of infection below 0.79 and iNCK costs below US$25.90, the iNCK remained cost-effective compared with current local standard of care. CONCLUSION The distribution of the iNCK dominated the current local standard of care (ie, the iNCK is less costly and more effective than current care standards). Most of the cost-effectiveness of the iNCK was attributable to a reduction in neonatal infection.
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Affiliation(s)
- Fiona Muttalib
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Karen Chung
- Dalla Lana School of Public Health, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Lisa Grace Pell
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shabina Ariff
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Soofi
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shaun K Morris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Dalla Lana School of Public Health, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
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Merckx J, Morris SK, Bitnun A, Gill P, El Tal T, Laxer RM, Yeh A, Yea C, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Hernandez-de Mezerville M, Papenburg J, Lefebvre MA, Nateghian A, Haghighi Aski B, Manafi A, Dwilow R, Bullard J, Cooke S, Dewan T, Restivo L, Lopez A, Sadarangani M, Roberts A, Barton M, Petel D, Le Saux N, Bowes J, Purewal R, Lautermilch J, Tehseen S, Bayliss A, Wong JK, Viel-Thériault I, Piche D, Top KA, Leifso K, Foo C, Panetta L, Robinson J. Infants hospitalized for acute COVID-19: disease severity in a multicenter cohort study. Eur J Pediatr 2022; 181:2535-2539. [PMID: 35217918 PMCID: PMC8880297 DOI: 10.1007/s00431-022-04422-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: 11/24/2021] [Revised: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 02/02/2023]
Abstract
Age is the most important determinant of COVID-19 severity. Infectious disease severity by age is typically J-shaped, with infants and the elderly carrying a high burden of disease. We report on the comparative disease severity between infants and older children in a multicenter retrospective cohort study of children 0 to 17 years old admitted for acute COVID-19 from February 2020 through May 2021 in 17 pediatric hospitals. We compare clinical and laboratory characteristics and estimate the association between age group and disease severity using ordinal logistic regression. We found that infants comprised one-third of cases, but were admitted for a shorter period (median 3 days IQR 2-5 versus 4 days IQR 2-7), had a lower likelihood to have an increased C-reactive protein, and had half the odds of older children of having severe or critical disease (OR 0.50 (95% confidence interval 0.32-0.78)). Conclusion: When compared to older children, there appeared to be a lower threshold to admit infants but their length of stay was shorter and they had lower odds than older children of progressing to severe or critical disease. What is Known: • A small proportion of children infected with SARS-CoV-2 require hospitalization for acute COVID-19 with a subgroup needing specialized intensive care to treat more severe disease. • For most infectious diseases including viral respiratory tract infections, disease severity by age is J-shaped, with infants having more severe disease compared to older children. What is New: • One-third of admitted children for acute COVID-19 during the first 14 months of the pandemic were infants. • Infants had half the odds of older children of having severe or critical disease.
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Affiliation(s)
- Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, McGill College, Suite 1200, Montreal, QC, H3A 1G1, Canada.
| | - Shaun K. Morris
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ronald M. Laxer
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Marcela Hernandez-de Mezerville
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Jesse Papenburg
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, McGill College, Suite 1200, Montreal, QC H3A 1G1 Canada ,Department of Pediatrics, McGill University, Montreal, QC Canada
| | | | - Alireza Nateghian
- Department of Pediatrics, University of Medical Sciences, Tehran, Iran
| | | | - Ali Manafi
- Department of Pediatrics, University of Medical Sciences, Tehran, Iran
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Alison Lopez
- British Columbia Children’s Hospital, Vancouver, BC Canada
| | - Manish Sadarangani
- British Columbia Children’s Hospital, Vancouver, BC Canada ,Department of Pediatrics, University of British Columbia, Vancouver, BC Canada ,Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Ashley Roberts
- British Columbia Children’s Hospital, Vancouver, BC Canada ,Department of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, ON Canada
| | - Dara Petel
- Department of Pediatrics, Western University, London, ON Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, ON Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, ON Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK Canada
| | - Sarah Tehseen
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK Canada
| | - Ann Bayliss
- Department of Pediatrics, Trillium Health Partners, Mississauga, ON Canada
| | | | | | - Dominique Piche
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Karina A. Top
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Kirk Leifso
- Department of Pediatrics, Queen’s University, Kingston, ON Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University, St John’s, Newfoundland and Labrador, Canada
| | - Luc Panetta
- Department of Pediatrics, Université de Montréal, Montreal, QC Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB Canada
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Nasreen S, Wang J, Kwong JC, Crowcroft NS, Sadarangani M, Wilson SE, McGeer A, Kellner JD, Quach C, Morris SK, Sander B, Kus JV, Naus M, Hoang L, Rudzicz F, Fadel S, Marra F. Population-based incidence of invasive pneumococcal disease in children and adults in Ontario and British Columbia, 2002-2018: A Canadian Immunization Research Network (CIRN) study. Vaccine 2021; 39:7545-7553. [PMID: 34810001 DOI: 10.1016/j.vaccine.2021.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/01/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) burden, evaluated in Canada using reported confirmed cases in surveillance systems, is likely underestimated due to underreporting. We estimated the burden of IPD in Ontario and British Columbia (BC) by combining surveillance data with health administrative databases. METHODS We established a cohort of 27,525 individuals in Ontario and BC. Laboratory-confirmed IPD cases were identified from Ontario's integrated Public Health Information System and the BC Centre for Disease Control Public Health Laboratory. Possible IPD cases were identified from hospitalization data in both provinces, and from emergency department visit data in Ontario. We estimated the age and sex adjusted annual incidence of IPD and pneumococcal conjugate/polysaccharide vaccine (PCV/PPV) serotype-specific IPD using Poisson regression models. RESULTS In Ontario, 20,205 overall IPD cases, including 15,299 laboratory-confirmed cases, were identified with relatively stable age- and sex-adjusted annual incidence rates ranging from 13.7/100,000 (2005) to 13.6/100,000 (2018). In BC, 7,320 overall IPD cases, including 5,932 laboratory-confirmed cases were identified; annual incidence rates increased from 10.9/100,000 (2002) to 13.2/100,000 (2018). Older adults aged ≥ 85 years had the highest incidence rates. During 2007-2018 the incidence of PCV7 serotypes and additional PCV13 serotypes decreased while the incidence of unique PPV23 and non-vaccine serotypes increased in both provinces. CONCLUSIONS IPD continues to cause a substantial public health burden in Canada despite publicly funded pneumococcal vaccination programs, resulting in part from an increase in unique PPV23 and non-vaccine serotypes.
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Affiliation(s)
- Sharifa Nasreen
- Centre for Vaccine Preventable Diseases, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Jun Wang
- Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Centre for Vaccine Preventable Diseases, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- Centre for Vaccine Preventable Diseases, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Manish Sadarangani
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Sarah E Wilson
- Centre for Vaccine Preventable Diseases, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Allison McGeer
- Centre for Vaccine Preventable Diseases, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Sinai Health System, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - James D Kellner
- Department of Pediatrics, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
| | - Caroline Quach
- Departments of Microbiology, Infectious Diseases & Immunology and Pediatrics, University of Montreal, Quebec, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children, and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Julianne V Kus
- Public Health Ontario, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Monika Naus
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Linda Hoang
- BC Centre for Disease Control, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frank Rudzicz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Department of Computer Science, Faculty of Arts & Science, University of Toronto, Toronto, Ontario, Canada; Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
| | - Shaza Fadel
- Centre for Vaccine Preventable Diseases, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
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Morris SK, Giroux RJP, Consunji-Araneta R, Stewart K, Baikie M, Kakkar F, Zielinski D, Tse-Chang A, Cook VJ, Fisher DA, Salvadori MI, Pernica JM, Sauve LJ, Hui C, Miners A, Alvarez GG, Al-Azem A, Gallant V, Grueger B, Lam R, Langley JM, Radziminski N, Rea E, Wong S, Kitai I. Epidemiology, clinical features and outcomes of incident tuberculosis in children in Canada in 2013-2016: results of a national surveillance study. Arch Dis Child 2021; 106:1165-1170. [PMID: 34417191 DOI: 10.1136/archdischild-2021-322092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/05/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Childhood tuberculosis disease is difficult to diagnose and manage and is an under-recognised cause of morbidity and mortality. Reported data from Canada do not focus on childhood tuberculosis or capture key epidemiologic, clinical and microbiologic details. The purpose of this study was to assess demographics, presentation and clinical features of childhood tuberculosis in Canada. METHODS We conducted prospective surveillance from 2013 to 2016 of over 2700 paediatricians plus vertical tuberculosis programmes for incident tuberculosis disease in children younger than 15 years in Canada using the Canadian Paediatric Surveillance Program (CPSP). RESULTS In total, 200 cases are included in this study. Tuberculosis was intrathoracic in 183 patients of whom 86% had exclusively intrathoracic involvement. Central nervous system tuberculosis occurred in 16 cases (8%). Fifty-one per cent of cases were hospitalised and 11 (5.5%) admitted to an intensive care unit. Adverse drug reactions were reported in 9% of cases. The source case, most often a first-degree relative, was known in 73% of cases. Fifty-eight per cent of reported cases were Canadian-born Indigenous children. Estimated study rates of reported cases (per 100 000 children per year) were 1.2 overall, 8.6 for all Indigenous children and 54.3 for Inuit children. CONCLUSION Childhood tuberculosis may cause significant morbidity and resource utilisation. Key geographies and groups have very high incidence rates. Elimination of childhood tuberculosis in Canada will require well-resourced community-based efforts that focus on these highest risk groups.
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Affiliation(s)
- Shaun K Morris
- Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada .,University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ryan J P Giroux
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Kristoffor Stewart
- Saskatchewan Infectious Disease Care Network, Saskatoon, Saskatchewan, Canada
| | | | - Fatima Kakkar
- Pediatric Infectious Diseases, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - David Zielinski
- Division of Respiratory Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alena Tse-Chang
- University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Victoria J Cook
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Marina I Salvadori
- London Health Sciences Centre Children's Hospital, London, Ontario, Canada.,Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jeffrey M Pernica
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Laura J Sauve
- The University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Charles Hui
- Childrens Hosp Eastern Ontario, Ottawa, Ontario, Canada
| | - Amber Miners
- Qikiqtani General Hospital, Iqaluit, Nunavut, Canada
| | - Gonzalo G Alvarez
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Assaad Al-Azem
- Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada.,University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Ray Lam
- Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Joanne M Langley
- Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Nicole Radziminski
- Stanton Territorial Hospital, Yellowknife, Northwest Territories, Canada
| | | | - Sam Wong
- University of Alberta, Edmonton, Alberta, Canada.,Stanton Territorial Hospital, Yellowknife, Northwest Territories, Canada
| | - Ian Kitai
- Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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48
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Drouin O, Hepburn CM, Farrar DS, Baerg K, Chan K, Cyr C, Donner EJ, Embree JE, Farrell C, Forgie S, Giroux R, Kang KT, King M, Laffin M, Luu TM, Orkin J, Papenburg J, Pound CM, Price VE, Purewal R, Sadarangani M, Salvadori MI, Top KA, Viel-Thériault I, Kakkar F, Morris SK. Caractéristiques des hospitalisations au Canada d’enfants ayant contracté une infection aiguë par le SRAS-CoV-2 en 2020. CMAJ 2021; 193:E1774-E1785. [PMID: 34810167 PMCID: PMC8608451 DOI: 10.1503/cmaj.210053-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 11/05/2022] Open
Abstract
Contexte: Les facteurs de risque de complications graves de l’infection par le SRAS-CoV-2 n’ont pas été bien établis chez les enfants. Nous avons voulu décrire les hospitalisations pédiatriques associées au SRAS-CoV-2 au Canada et identifier les facteurs de risque de maladie grave. Méthodes: Nous avons procédé à une étude prospective nationale en utilisant l’infrastructure du Programme canadien de surveillance pédiatrique (PCSP). Les hospitalisations d’enfants ayant contracté une infection par le SRAS-CoV-2 confirmée en laboratoire de microbiologie ont été rapportées du 8 avril au 31 décembre 2020 au moyen de questionnaires hebdomadaires en ligne distribués au réseau du PCSP, qui compte plus de 2800 pédiatres. Nous avons catégorisé les hospitalisations comme suit : liées à la COVID-19, infections découvertes fortuitement, ou hospitalisations pour des raisons sociales ou de contrôle des infections, et dégagé les facteurs de risque associés à la gravité de la maladie chez les patients hospitalisés. Résultats: Sur les 264 hospitalisations d’enfants ayant contracté le SRAS-CoV-2 au cours de la période de l’étude de 9 mois, 150 (56,8 %) ont été associées à la COVID-19 et 100 (37,9 %) étaient des cas découverts fortuitement (admission pour d’autres raisons et découverte fortuite du SRAS-CoV-2 par dépistage positif). Les nourrissons (37,3 %) et les adolescents (29,6 %) représentaient la majorité des cas. Parmi les hospitalisations liées à la COVID-19, 52 patients (34,7 %) étaient atteints d’une forme grave de la maladie, dont 42 (28,0 % des cas liés à la COVID-19) ont eu besoin d’une forme d’assistance respiratoire ou hémodynamique, et 59 (39,3 %) présentaient au moins 1 comorbidité sous-jacente. Les enfants atteints d’obésité, de maladies neurologiques chroniques ou de maladies pulmonaires chroniques, à l’exclusion de l’asthme, étaient plus susceptibles de présenter une forme grave ou critique de la COVID-19. Interprétation: Parmi les enfants hospitalisés au Canada chez lesquels on a diagnostiqué une infection par le SRAS-CoV-2 au début de la pandémie de COVID-19, la découverte fortuite du SRAS-CoV-2 a été fréquente. Chez les enfants hospitalisés pour une COVID-19 aiguë, l’obésité et les comorbidités neurologiques et respiratoires ont été associées à une gravité accrue.
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Affiliation(s)
- Olivier Drouin
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Charlotte Moore Hepburn
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Daniel S Farrar
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Krista Baerg
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Kevin Chan
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Claude Cyr
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Elizabeth J Donner
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Joanne E Embree
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Catherine Farrell
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Sarah Forgie
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Ryan Giroux
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Kristopher T Kang
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Melanie King
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Melanie Laffin
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Thuy Mai Luu
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Julia Orkin
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Jesse Papenburg
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Catherine M Pound
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Victoria E Price
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Rupeena Purewal
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Manish Sadarangani
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Marina I Salvadori
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Karina A Top
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Isabelle Viel-Thériault
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont
| | - Fatima Kakkar
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont.
| | - Shaun K Morris
- Unités de pédiatrie générale (Drouin, Luu) et de soins intensifs pédiatriques (Farrell), Département of pédiatrie, et Service des maladies infectieuses (Kakkar), Centre hospitalier universitaire Sainte-Justine; Département de médecine sociale et préventive (Drouin), École de santé publique de l'Université de Montréal, Montréal, Qc; Division de médecine pédiatrique (Moore Hepburn, Giroux, Orkin), Centre for Global Child Health (Farrar, Morris) et Child Health Evaluative Sciences (Morris, Orkin), Hôpital pour enfants malades; Institut pour les politiques, la gestion et l'évaluation de la santé (Moore Hepburn) et départements de pédiatrie (Chan) et de santé publique clinique (Morris), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Département de pédiatrie (Baerg, Purewal), Université de la Saskatchewan; Divisions de pédiatrie générale (Baerg) et d'infectiologie pédiatrique (Purewal), Hôpital pour enfants Jim Pattison, Autorité sanitaire de la Saskatchewan, Saskatoon, Sask.; Département de santé infantile et féminine (Chan), Trillium Health Partners, Mississauga, Ont.; Service de soins intensifs pédiatriques (Cyr), Centre hospitalier et Faculté de médecine (Cyr), Université de Sherbrooke, Sherbrooke, Qc.; Départements de pédiatrie et de santé de l'enfant (Embree) et microbiologie médicale et infectiologie (Embree), Universi té du Mani toba, Winnipeg, Man.; Division d'infectiologie (Forgie), Département de pédiatrie, Université de l'Alberta; Hôpital pour enfants Stollery (Forgie), Edmonton, Alb.; Département de pédiatrie (Sadarangani, Tang), Université de la Colombie-Britannique, Vancouver, C.-B.; Programme canadien de surveillance pédiatrique (King, Laffin), Société canadienne de pédiatrie, Ottawa, Ont.; Division d'infectiologie pédiatrique (Papenburg), Département de pédiatrie, Hôpital de Montréal pour enfants; Division de microbiologie (Papenburg), Département clinique de médecine de laboratoire, Centre universitaire de santé McGill, Montréal, Qc; Division de pédiatrie générale (Pound), Département de pédiatrie, Centre hospitalier pour enfants de l'est de l'Ontario, Ottawa, Ont.; Division d'hématologie/oncologie pédiatrique (Price), Département de pédiatrie, Université Dalhousie, Halifax, N.-É.; Vaccine Evaluation Center (Sadarangani), Institut de recherche de l'Hôpital pour enfants de la Colombie-Britannique, Vancouver, C.-B.; Agence de la santé publique du Canada (Salvadori), Ottawa, Ont.; Département de pédiatrie (Top), Université Dalhousie, Halifax, N.-É.; Division d'infectiologie (Viel-Thériault), Département de pédiatrie, CHU de Québec-Université Laval, Québec, Qc; Divisions d'infectiologie (Morris) et de neurologie (Donner), Hôpital pour enfants malades; Université de Toronto, Toronto, Ont.
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Yeung T, Chung E, Chen J, Erdman LK, Smiljkovic M, Wong W, Rolnitsky A, Morris SK, El Shahed A, Banihani R, Bitnun A, Tomlinson C. Therapeutic Drug Monitoring of Moxifloxacin to Guide Treatment of Mycoplasma hominis Meningitis in an Extremely Preterm Infant. J Pediatr Pharmacol Ther 2021; 26:857-862. [PMID: 34790077 DOI: 10.5863/1551-6776-26.8.857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/27/2021] [Indexed: 11/11/2022]
Abstract
Mycoplasma hominis (M hominis) is a rare cause of neonatal bacterial meningitis. Treatment can be challenging because of M hominis' intrinsic antibiotic resistance and the difficulty in accessing antimicrobial susceptibility testing. In this report, we describe an extremely preterm male infant with seizures who had a subsequent diagnosis of M hominis meningitis. Because of severity of illness, doxycycline (4 mg/kg IV every 24 hours) and moxifloxacin (5 mg/kg IV every 24 hours) were started empirically. Repeat cerebrospinal fluid cultures were negative and showed decreasing pleiocytosis. Given the concentration-dependent killing of moxifloxacin and concern for endovascular infection from a concomitant cerebral venous sinus thrombosis, serum concentrations of moxifloxacin were obtained to estimate pharmacokinetic and pharmacodynamic parameters. These were compared to the targets described in other case reports of M hominis meningitis. The maximum serum concentration (Cmax) was 2.5 mg/L, volume of distribution was 2.2 L/kg, clearance was 0.18 L/kg/hr, terminal half-life was 8.6 hours, and area-under-the-concentration-time curve (AUC) was 28.1 mg•hr/L. Using the range of minimum inhibitory concentrations (MICs) reported in the literature, the estimated Cmax/MIC for this patient was 21 to 158 (target Cmax/MIC: >10) and AUC/MIC was 234 to 1757 (target AUC/MIC: ≥100). Doxycycline and moxifloxacin were continued for 6 weeks. No adverse events to moxifloxacin or doxycycline were observed in the NICU. This report describes the successful treatment of M hominis neonatal meningitis and adds to the knowledge of pharmacokinetic and pharmacodynamic parameters of moxifloxacin in neonates. Additional data will help to confirm the role for routine therapeutic drug monitoring of moxifloxacin in neonates.
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50
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Berry I, Mangtani P, Rahman M, Khan IA, Sarkar S, Naureen T, Greer AL, Morris SK, Fisman DN, Flora MS. Population Health Surveillance Using Mobile Phone Surveys in Low- and Middle-Income Countries: Methodology and Sample Representativeness of a Cross-sectional Survey of Live Poultry Exposure in Bangladesh. JMIR Public Health Surveill 2021; 7:e29020. [PMID: 34766914 PMCID: PMC8663489 DOI: 10.2196/29020] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background Population-based health surveys are typically conducted using face-to-face household interviews in low- and middle-income countries (LMICs). However, telephone-based surveys are cheaper, faster, and can provide greater access to hard-to-reach or remote populations. The rapid growth in mobile phone ownership in LMICs provides a unique opportunity to implement novel data collection methods for population health surveys. Objective This study aims to describe the development and population representativeness of a mobile phone survey measuring live poultry exposure in urban Bangladesh. Methods A population-based, cross-sectional, mobile phone survey was conducted between September and November 2019 in North and South Dhaka City Corporations (DCC), Bangladesh, to measure live poultry exposure using a stratified probability sampling design. Data were collected using a computer-assisted telephone interview platform. The call operational data were summarized, and the participant data were weighted by age, sex, and education to the 2011 census. The demographic distribution of the weighted sample was compared with external sources to assess population representativeness. Results A total of 5486 unique mobile phone numbers were dialed, with 1047 respondents completing the survey. The survey had an overall response rate of 52.2% (1047/2006) and a co-operation rate of 89.0% (1047/1176). Initial results comparing the sociodemographic profile of the survey sample to the census population showed that mobile phone sampling slightly underrepresented older individuals and overrepresented those with higher secondary education. After weighting, the demographic profile of the sample population matched well with the latest DCC census population profile. Conclusions Probability-based mobile phone survey sampling and data collection methods produced a population-representative sample with minimal adjustment in DCC, Bangladesh. Mobile phone–based surveys can offer an efficient, economic, and robust way to conduct surveillance for population health outcomes, which has important implications for improving population health surveillance in LMICs.
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Affiliation(s)
- Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Punam Mangtani
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mahbubur Rahman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Iqbal Ansary Khan
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Sudipta Sarkar
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Tanzila Naureen
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Amy L Greer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - Shaun K Morris
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Division of Infectious Disease and Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - David N Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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