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O’Brien SF, Deeks SL, Hatchette T, Pambrun C, Drews SJ. SARS-CoV-2 seroprevalence in Nova Scotia blood donors. J Assoc Med Microbiol Infect Dis Can 2024; 9:32-45. [PMID: 38567363 PMCID: PMC10984316 DOI: 10.3138/jammi-2023-0017] [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: 06/09/2023] [Revised: 10/20/2023] [Accepted: 11/09/2023] [Indexed: 04/04/2024]
Abstract
Background SARS-CoV-2 seroprevalence monitors cumulative infection rates irrespective of case testing protocols. We aimed to describe Nova Scotia blood donor seroprevalence in relation to public health policy and reported data over the course of the COVID-19 pandemic (May 2020 to August 2022). Methods Monthly random Nova Scotia blood donation samples (24,258 in total) were tested for SARS-CoV-2 infection antibodies (anti-nucleocapsid) from May 2020 to August 2022, and vaccination antibodies (anti-spike) from January 2021 to August 2022. Multivariable logistic regression for infection antibodies and vaccination antibodies separately with month, age, sex, and racialization identified independent predictors. The provincial nucleic acid amplification test (NAAT)-positive case rate over the pandemic was calculated from publicly available data. Results Anti-N seroprevalence was 3.8% in January 2022, increasing to 50.8% in August 2022. The general population COVID-19 case rate was 3.5% in January 2022, increasing to 12.5% in August 2022. The percentage of NAAT-positive samples in public health laboratories increased from 1% in November 2021 to a peak of 30.7% in April 2022 with decreasing numbers of tests performed. Higher proportions of younger donors as well as Black, Indigenous, and racialized blood donors were more likely to have infection antibodies (p < 0.01). Vaccination antibodies increased to 100% over 2021, initially in older donors (60+ years), and followed by progressively younger age groups. Conclusions SARS-CoV-2 infection rates were relatively low in Nova Scotia until the more contagious Omicron variant dominated, after which about half of Nova Scotia donors had been infected despite most adults being vaccinated (although severity was much lower in vaccinated individuals). Most COVID-19 cases were detected by NAAT until Omicron arrived. When NAAT testing priorities focused on high-risk individuals, infection rates were better reflected by seroprevalence.
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Affiliation(s)
- Sheila F O’Brien
- Epidemiology & Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ontario, Canada
| | - Shelley L Deeks
- Department of Health and Wellness, Government of Nova Scotia, Halifax, Nova Scotia, Canada
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd Hatchette
- Division of Microbiology, Nova Scotia Health, Central Zone, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chantale Pambrun
- Medical Affairs & Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Steven J Drews
- Microbiology, Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Pathology & Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada
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Wright J, Science M, Osman S, Arnold C, Sumaida M, Crowcroft N, Deeks SL, Brown K, Halperin S, Hatchette T, McLachlan E, Campigotto A, Richardson S, Bolotin S. Uptake of pertussis immunization in pregnancy and determinants of vaccination in Toronto, Canada. Vaccine 2023; 41:6895-6898. [PMID: 37845156 DOI: 10.1016/j.vaccine.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Pertussis causes significant morbidity and mortality in infants aged <6 months. Maternal pertussis vaccination during pregnancy has been recommended in Canada since 2018 to reduce these negative outcomes. In the absence of routine immunization coverage data, our objective was to evaluate uptake in Toronto, Canada. METHODS We recruited mother-infant pairs at The Hospital for Sick Children, Toronto, between 2018 and 2020. We performed logistic regression to examine associations between demographics and self-reported pertussis vaccination. RESULTS 76/243 mothers (31.3 %) reported receiving pertussis vaccination during their most recent pregnancy. Odds of receiving vaccination more than doubled with each 1-year increase in year of pregnancy (aOR: 2.2; 95 % CI: 1.3, 3.6; p < 0.01) and among those born in Canada as compared to those not (aOR: 2.0; 95 % CI: 1.1, 3.6; p = 0.02) CONCLUSION: Uptake of pertussis vaccination during pregnancy in Ontario has increased in recent years, however coverage remains lower than desirable.
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Affiliation(s)
| | - Michelle Science
- Public Health Ontario, Toronto, Ontario, Canada; Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto Canada; Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Selma Osman
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Callum Arnold
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Biology, Pennsylvania State University, University Park, PA 16802, USA; Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA 16802, USA
| | - Maya Sumaida
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Natasha Crowcroft
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA 16802, USA; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Community Health and Epidemiology, Dalhousie University
| | - Kevin Brown
- Public Health Ontario, Toronto, Ontario, Canada
| | - Scott Halperin
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Todd Hatchette
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Elizabeth McLachlan
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Aaron Campigotto
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto Canada
| | - Susan Richardson
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto Canada
| | - Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada; Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto Canada.
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3
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Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Grace D, Grewal R, Jollimore J, Lachowsky N, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Coutlée F, Burchell AN. Vaccine Effectiveness Against 12-Month Incident and Persistent Anal Human Papillomavirus Infection Among Gay, Bisexual, and Other Men Who Have Sex With Men. J Infect Dis 2023; 228:89-100. [PMID: 36655513 PMCID: PMC10304758 DOI: 10.1093/infdis/jiad005] [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: 07/29/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Real-world evidence of human papillomavirus (HPV) vaccine effectiveness (VE) against longitudinal outcomes is lacking among gay, bisexual, and other men who have sex with men (GBM). We compared 12-month incidence and persistence of anal HPV infection between vaccinated and unvaccinated GBM. METHODS We recruited GBM aged 16-30 years in Montreal, Toronto, and Vancouver, Canada, from 2017 to 2019. Participants were followed over a median of 12 months (interquartile range, 12-13 months). Participants self-reported HPV vaccination and self-collected anal specimens for HPV DNA testing. We calculated prevalence ratios (PR) for 12-month cumulative incidence and persistence with ≥1 quadrivalent vaccine type (HPV 6/11/16/18) between vaccinated (≥1 dose at baseline) and unvaccinated participants using a propensity score-weighted, modified Poisson regression. RESULTS Among 248 participants, 109 (44.0%) were vaccinated at baseline, of whom 62.6% received 3 doses. PRs for HPV 6/11/16/18 were 0.56 (95% confidence interval [CI], .24-1.31) for cumulative incidence and 0.53 (95% CI, .25-1.14) for persistence. PRs were 0.23 (95% CI, .05-1.03) and 0.08 (95% CI, .01-.59) for incidence and persistence, respectively, among participants who received their first dose at age ≤23 years and 0.15 (95% CI, .03-.68) and 0.12 (95% CI, .03-.54) among participants who were sexually active for ≤5 years before vaccination. CONCLUSIONS Findings support national recommendations for HPV vaccination at younger ages or soon after sexual debut.
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Affiliation(s)
- Catharine Chambers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Government of Nova Scotia, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Joseph Cox
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - Alexandra de Pokomandy
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Rosane Nisenbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantal Sauvageau
- Institut National de Santé Publique du Québec, Québec, Québec, Canada
| | | | - François Coutlée
- Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Buchan SA, Chung H, To T, Daneman N, Guttmann A, Kwong JC, Murti M, Aryal G, Campigotto A, Chakraborty P, Gubbay J, Karnauchow T, Katz K, McGeer AJ, McNally JD, Mubareka S, Richardson D, Richardson SE, Smieja M, Zahariadis G, Deeks SL. Estimating the incidence of first RSV hospitalization in children born in Ontario, Canada. J Pediatric Infect Dis Soc 2023:piad045. [PMID: 37335754 PMCID: PMC10389057 DOI: 10.1093/jpids/piad045] [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: 02/02/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) contributes significantly to morbidity in children, placing substantial burdens on health systems, thus RSV vaccine development and program implementation are a public health priority. More data on burden are needed by policymakers to identify priority populations and formulate prevention strategies as vaccines are developed and licensed. MATERIALS/METHODS Using health administrative data, we calculated incidence rates of RSV hospitalization in a population-based birth cohort of all children born over a six-year period (May 2009 - June 2015) in Ontario, Canada. Children were followed until their first RSV hospitalization, death, 5 th birthday, or the end of the study period (June 2016). RSV hospitalizations were identified using a validated algorithm based on International Classification of Diseases, 10 th Revision, and/or laboratory-confirmed outcomes. We calculated hospitalization rates by various characteristics of interest, including calendar month, age groups, sex, comorbidities, and gestational age. RESULTS The overall RSV hospitalization rate for children <5 years was 4.2 per 1,000 person-years (PY) with a wide range across age groups (from 29.6 to 0.52 per 1000PY in children aged 1 month and 36-59 months, respectively). Rates were higher in children born at a younger gestational age (23.2 per 1000PY for those born at <28 weeks versus 3.9 per 1000PY born at ≥37 weeks); this increased risk persisted as age increased. While the majority of children in our study had no comorbidities, rates were higher in children with comorbidities. For all age groups, rates were highest between December and March. CONCLUSIONS Our results confirm the high burden of RSV hospitalization and highlight young infants are at additional risk, namely premature infants. These results can inform prevention efforts.
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Affiliation(s)
- Sarah A Buchan
- Public Health Ontario, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | | | - Teresa To
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Astrid Guttmann
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Michelle Murti
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Garima Aryal
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Aaron Campigotto
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Jonathan Gubbay
- Public Health Ontario, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Timothy Karnauchow
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Pathology and Laboratory Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Kevin Katz
- North York General Hospital, Toronto, ON, Canada
| | - Allison J McGeer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | - J Dayre McNally
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Samira Mubareka
- Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Susan E Richardson
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Marek Smieja
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - George Zahariadis
- Newfoundland & Labrador Public Health Laboratory, St. John's, NF&L, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
- Nova Scotia Department of Health and Wellness, Halifax, NS, Canada
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5
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Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Grace D, Grewal R, Jollimore J, Lachowsky NJ, Mah A, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DH, Yeung A, Burchell AN. Self-reported Human Papillomavirus Vaccination and Vaccine Effectiveness Among Men Who Have Sex with Men: A Quantitative Bias Analysis. Epidemiology 2023; 34:225-229. [PMID: 36722804 PMCID: PMC9891269 DOI: 10.1097/ede.0000000000001580] [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] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/04/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Self-report of human papillomavirus (HPV) vaccination has ~80-90% sensitivity and ~75-85% specificity. We measured the effect of nondifferential exposure misclassification associated with self-reported vaccination on vaccine effectiveness (VE) estimates. METHODS Between 2017-2019, we recruited sexually active gay, bisexual, and other men who have sex with men aged 16-30 years in Canada. VE was derived as 1-prevalence ratio × 100% for prevalent anal HPV infection comparing vaccinated (≥1 dose) to unvaccinated men using a multivariable modified Poisson regression. We conducted a multidimensional and probabilistic quantitative bias analysis to correct VE estimates. RESULTS Bias-corrected VE estimates were relatively stable across sensitivity values but differed from the uncorrected estimate at lower values of specificity. The median adjusted VE was 27% (2.5-97.5th simulation interval = -5-49%) in the uncorrected analysis, increasing to 39% (2.5-97.5th simulation interval = 2-65%) in the bias-corrected analysis. CONCLUSION A large proportion of participants erroneously reporting HPV vaccination would be required to meaningfully change VE estimates.
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Affiliation(s)
- Catharine Chambers
- From the University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Government of Nova Scotia, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rinku Sutradhar
- From the University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Joseph Cox
- McGill University, Montréal, Québec, Canada
- Direction régionale de santé publique de Montréal, Montréal, Québec, Canada
| | | | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Trevor A. Hart
- From the University of Toronto, Toronto, Ontario, Canada
- Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, Montréal, Québec, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver British Columbia, Canada
| | - Daniel Grace
- From the University of Toronto, Toronto, Ontario, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | | | - Ashley Mah
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- From the University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantal Sauvageau
- Institut national de santé publique du Québec, Québec, Québec, Canada
| | | | - Anna Yeung
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Ann N. Burchell
- From the University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
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6
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Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Coutlée F, Burchell AN. Anal Human Papillomavirus Prevalence Among Vaccinated and Unvaccinated Gay, Bisexual, and Other Men Who Have Sex With Men in Canada. Sex Transm Dis 2022; 49:123-132. [PMID: 34561370 PMCID: PMC8746886 DOI: 10.1097/olq.0000000000001560] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Starting in 2015, human papillomavirus (HPV) vaccine has been publicly funded for gay, bisexual, and other men who have sex with men (GBM) 26 years or younger in Canada. METHODS Self-identified GBM who reported having sex with another man within the past 6 months were enrolled using respondent-driven sampling (RDS) between February 2017 and August 2019 in Montreal, Toronto, and Vancouver, Canada. Men aged 16 to 30 years self-collected anal specimens for HPV-DNA testing. Prevalence was estimated using RDS-II weights. We compared the prevalence of quadrivalent (HPV-6/11/16/18) and 9-valent (HPV-6/11/16/18/31/33/45/52/58) vaccine types between GBM who self-reported HPV vaccination (≥1 dose) and those reporting no vaccination using a modified Poisson regression for binary outcomes. RESULTS Among 645 GBM who provided a valid anal specimen (median age, 26 years; 5.9% HIV positive), 40.3% reported receiving ≥1 dose of HPV vaccine, of whom 61.8% received 3 doses. One-quarter were infected with ≥1 quadrivalent type (crude, 25.7%; RDS weighted, 24.4%). After adjustment for potential confounders, vaccinated GBM had a 27% lower anal prevalence of quadrivalent types compared with unvaccinated GBM (adjusted prevalence ratio [aPR], 0.73; 95% confidence interval [CI], 0.54-1.00). Lower prevalence ratios were found among vaccinated participants who were vaccinated >2 years before enrollment (aPR, 0.47; 95% CI, 0.25-0.86) or received their first vaccine dose at age ≤23 years (aPR, 0.64; 95% CI, 0.42-0.99). Point estimates were similar for ≥2 or 3 doses and 9-valent types. CONCLUSIONS Human papillomavirus vaccination was associated with a lower anal prevalence of vaccine-preventable HPV types among young, sexually active GBM. Findings will help inform shared decision making around HPV vaccination for GBM and their healthcare providers.
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Affiliation(s)
- Catharine Chambers
- From the Dalla Lana School of Public Health, University of Toronto
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Unity Health Toronto, Toronto
| | - Shelley L. Deeks
- From the Dalla Lana School of Public Health, University of Toronto
- Department of Health and Wellness, Government of Nova Scotia, Halifax
| | - Rinku Sutradhar
- From the Dalla Lana School of Public Health, University of Toronto
- ICES, Sunnybrook Research Institute, Toronto
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University
| | | | - Troy Grennan
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver
| | - Trevor A. Hart
- From the Dalla Lana School of Public Health, University of Toronto
- Department of Psychology, Ryerson University, Toronto
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, Montréal
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver
| | - François Coutlée
- Département de microbiologie, infectiologie et immunologie, Université de Montréal
- Laboratoire de virologie moléculaire, Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal
| | - Ann N. Burchell
- From the Dalla Lana School of Public Health, University of Toronto
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Unity Health Toronto, Toronto
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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7
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Bolotin S, Tran V, Deeks SL, Peci A, Brown KA, Buchan SA, Ogbulafor K, Ramoutar T, Nguyen M, Thakkar R, DelaCruz R, Mustfa R, Maregmen J, Woods O, Krasna T, Cronin K, Osman S, Joh E, Allen VG. Assessment of population infection with SARS-CoV-2 in Ontario, Canada, March to June 2020. Euro Surveill 2021; 26. [PMID: 34915969 PMCID: PMC8728493 DOI: 10.2807/1560-7917.es.2021.26.50.2001559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Serosurveys for SARS-CoV-2 aim to estimate the proportion of the population that has been infected. Aim This observational study assesses the seroprevalence of SARS-CoV-2 antibodies in Ontario, Canada during the first pandemic wave. Methods Using an orthogonal approach, we tested 8,902 residual specimens from the Public Health Ontario laboratory over three time periods during March–June 2020 and stratified results by age group, sex and region. We adjusted for antibody test sensitivity/specificity and compared with reported PCR-confirmed COVID-19 cases. Results Adjusted seroprevalence was 0.5% (95% confidence interval (CI): 0.1–1.5) from 27 March–30 April, 1.5% (95% CI: 0.7–2.2) from 26–31 May, and 1.1% (95% CI: 0.8–1.3) from 5–30 June 2020. Adjusted estimates were highest in individuals aged ≥ 60 years in March–April (1.3%; 95% CI: 0.2–4.6), in those aged 20–59 years in May (2.1%; 95% CI: 0.8–3.4) and in those aged ≥ 60 years in June (1.6%; 95% CI: 1.1–2.1). Regional seroprevalence varied, and was highest for Toronto in March–April (0.9%; 95% CI: 0.1–3.1), for Toronto in May (3.2%; 95% CI: 1.0–5.3) and for Toronto (1.5%; 95% CI: 0.9–2.1) and Central East in June (1.5%; 95% CI: 1.0–2.0). We estimate that COVID-19 cases detected by PCR in Ontario underestimated SARS-CoV-2 infections by a factor of 4.9. Conclusions Our results indicate low population seroprevalence in Ontario, suggesting that public health measures were effective at limiting the spread of SARS-CoV-2 during the first pandemic wave.
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Affiliation(s)
- Shelly Bolotin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Vanessa Tran
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | | | - Kevin A Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Sarah A Buchan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | | | | | | | | | | | - Reem Mustfa
- Public Health Ontario, Toronto, Ontario, Canada
| | | | | | - Ted Krasna
- Public Health Ontario, Toronto, Ontario, Canada
| | - Kirby Cronin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Selma Osman
- Public Health Ontario, Toronto, Ontario, Canada
| | - Eugene Joh
- Public Health Ontario, Toronto, Ontario, Canada
| | - Vanessa G Allen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
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8
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Grewal R, Deeks SL, Hart TA, Cox J, De Pokomandy A, Grennan T, Lambert G, Moore D, Coutlée F, Gaspar M, George C, Grace D, Jollimore J, Lachowsky NJ, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Yeung A, Burchell AN. Human papillomavirus (HPV) vaccination across a cascade of knowledge, willingness, and uptake among gay, bisexual, and other men who have sex with men in Canada's three largest cities. Hum Vaccin Immunother 2021; 17:5413-5425. [PMID: 34856869 DOI: 10.1080/21645515.2021.1979379] [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] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexual, and other men who have sex with men (GBM) aged ≤26 years. We characterized factors associated with being in different stages of HPV vaccination. METHODS Engage is a sexual health study of GBM in the three largest Canadian cities recruited via respondent driven sampling (RDS). We categorized participants as: (1) unaware of HPV vaccine, (2) undecided/unwilling to get vaccinated, (3) willing to get vaccinated, (4) vaccinated with one or more doses. Our RDS-II weighted analyses used multinomial logistic regression to identify factors associated with being in earlier stages of the cascade compared to Stage 4. RESULTS Across the cities, 26-40%, 7-14%, 33-39%, and 13-28% were in Stages 1 to 4, respectively. Compared to Stage 4, being in earlier stages of the cascade was associated with bisexual-identification (Stage 1: adjusted odds ratio[aOR] = 2.84, 95% confidence interval[CI] = 1.06-7.62; Stage 2: aOR = 3.09, 95%CI = 1.19-8.05), having immigrated to Canada (Stage 1: aOR = 1.79, 95%CI 1.07-2.99), preference to keep same-sex romantic relationships private (Stage 1: aOR = 1.25, 95% CI = 1.05-1.48; Stage 2: aOR = 1.24, 95%CI = 1.05-1.46), not receiving sexual health information (Stage 1: aOR = 0.31, 95% CI = 0.13-0.71; Stage 2: aOR = 0.27, 95%CI = 0.12-0.64), not accessing a health-care provider (Stage 2: aOR = 0.36, 95%CI = 0.15-0.83), and no past hepatitis A/B vaccination (Stage 1: aOR = 0.16, 95% CI = 0.09-0.30; Stage 2: aOR = 0.18, 95%CI = 0.09-0.35; Stage 3: aOR = 0.38, 95%CI = 0.21-0.61). DISCUSSION Interventions are needed to reduce social and financial barriers, increase sexual health knowledge, and improve GBM-competent health-care access to increase vaccine uptake among GBM.
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Affiliation(s)
- R Grewal
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - S L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Nova Scotia Department of Health and Wellness, Halifax, Canada
| | - T A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Psychology, Ryerson University, Toronto, Canada
| | - J Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Montréal, McGill University.,Direction régionale de santé publique, CIUSSS-Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - A De Pokomandy
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - T Grennan
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - G Lambert
- Direction régionale de santé publique, CIUSSS-Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - D Moore
- Department of Medicine, University of British Columbia, Vancouver, Canada.,BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - F Coutlée
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Canada.,Department of Microbiology and Immunology, Université de Montréal, Montréal, Canada
| | - M Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - C George
- Department of Exercise, Health, and Sport Sciences, University of Maine, Portland, USA
| | - D Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J Jollimore
- Community-Based Research Centre, Vancouver, Canada
| | - N J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Community-Based Research Centre, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - R Nisenbaum
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Applied Health Research Centre, Unity Health Toronto, Toronto, Canada
| | - G Ogilvie
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - C Sauvageau
- Faculty of Medicine, Université Laval, Québec City, Canada.,Institut National de santé publique du Québec, Québec, Canada
| | - D H S Tan
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - A Yeung
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - A N Burchell
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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9
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Crowcroft NS, Schwartz KL, Savage RD, Chen C, Johnson C, Li Y, Marchand-Austin A, Bolotin S, Deeks SL, Jamieson FB, Drews SJ, Russell ML, Svenson LW, Simmonds K, Righolt CH, Bell C, Mahmud SM, Kwong JC. A Call for Caution in Use of Pertussis Vaccine Effectiveness Studies to Estimate Waning Immunity: A Canadian Immunization Research Network Study. Clin Infect Dis 2021; 73:83-90. [PMID: 32384142 DOI: 10.1093/cid/ciaa518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vaccine effectiveness (VE) studies provide essential evidence on waning vaccine-derived immunity, a major threat to pertussis control. We evaluated how study design affects estimates by comparing 2 case-control studies conducted in Ontario, Canada. METHODS We compared results from a test-negative design (TND) with a frequency-matched design (FMD) case-control study using pertussis cases from 2005-2015. In the first study, we identified test-negative controls from the public health laboratory that diagnosed cases and, in the second, randomly selected controls from patients attending the same physicians that reported cases, frequency matched on age and year. We compared characteristics of cases and controls using standardized differences. RESULTS In both designs, VE estimates for the early years postimmunization were consistent with clinical trials (TND, 84%; FMD, 89% at 1-3 years postvaccination) but diverged as time since last vaccination increased (TND, 41%; FMD, 74% by 8 years postvaccination). Overall, we observed lower VE and faster waning in the TND than the FMD. In the TND but not FMD, controls differed from cases in important confounders, being younger, having more comorbidities, and higher healthcare use. Differences between the controls of each design were greater than differences between cases. TND controls were more likely to be unvaccinated or incompletely vaccinated than FMD controls (P < .001). CONCLUSIONS The FMD adjusted better for healthcare-seeking behavior than the TND. Duration of protection from pertussis vaccines is unclear because estimates vary by study design. Caution should be exercised by experts, researchers, and decision makers when evaluating evidence on optimal timing of boosters.
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Affiliation(s)
- Natasha S Crowcroft
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,St Joseph's Health Centre, Toronto, Ontario, Canada
| | - Rachel D Savage
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | | | - Ye Li
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | | | - Shelly Bolotin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Frances B Jamieson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Steven J Drews
- Medical Microbiology, Canadian Blood Service, Edmonton, Alberta, Canada.,Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Margaret L Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence W Svenson
- Alberta Health, Edmonton, Alberta, Canada.,Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Kimberley Simmonds
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christopher Bell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeffrey C Kwong
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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10
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Grewal R, Deeks SL, Hart TA, Cox J, De Pokomandy A, Grennan T, Lambert G, Moore D, Brisson M, Coutlée F, Gaspar M, George C, Grace D, Jollimore J, Lachowsky NJ, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Yeung A, Burchell AN. Human papillomavirus (HPV) vaccine uptake among a community-recruited sample of gay, bisexual, and other men who have sex with men in the three largest cities in Canada from 2017 to 2019. Vaccine 2021; 39:3756-3766. [PMID: 34074547 DOI: 10.1016/j.vaccine.2021.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/26/2021] [Accepted: 05/11/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION In 2015/2016, Canada's largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) ≤ 26 years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization. METHODS Engage is a cohort study among GBM aged 16 + years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS). Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26 years old = eligible for vaccination, ≥27 years old = ineligible), we described HPV vaccine uptake (initiation = 1 + dose, completion = 3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator. RESULTS Across the three cities, 26-35% and 14-21% of men ≤ 26 years and 7-26% and 2-9% of men ≥ 27 years initiated and completed HPV vaccination, respectively. Vaccine initiation was significantly associated with STI/HIV testing or visiting a HIV care specialist in the past six months (≤26: prevalence ratio[PR] = 2.15, 95% confidence interval[CI] 1.06-4.36; ≥27: PR = 2.73, 95%CI 1.14-6.51) and past hepatitis A or B vaccination (≤26: PR = 2.88, 95%CI 1.64-5.05; ≥27: PR = 2.03, 95%CI 1.07-3.86). Among men ≥ 27 years old, vaccine initiation was also positively associated with accessing PrEP, living in Vancouver or Toronto, but negatively associated with identifying as Latin American and increasing age. Vaccine initiation was twice as likely among men ≥ 27 years with private insurance versus no insurance. CONCLUSIONS Sixty-five to 74% of men eligible for publicly-funded vaccine across the three cities remained unvaccinated against HPV by 2019. High vaccine cost may partly explain even lower uptake among men ≥ 27 years old. Men seeking sexual health care were more likely to initiate vaccination; bundling vaccination with these services may help improve HPV vaccine uptake.
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Affiliation(s)
- R Grewal
- Unity Health Toronto, Canada; University of Toronto, Canada
| | - S L Deeks
- University of Toronto, Canada; Public Health Ontario, Canada
| | - T A Hart
- University of Toronto, Canada; Ryerson University, Canada
| | - J Cox
- McGill University, Canada; Direction régionale de santé publique - Montréal, Canada
| | | | - T Grennan
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - G Lambert
- Direction régionale de santé publique - Montréal, Canada
| | - D Moore
- University of British Columbia, Canada; BC Centre for Excellence in HIV/AIDS, Canada
| | | | - F Coutlée
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | | | - C George
- University of Southern Maine, United States
| | - D Grace
- University of Toronto, Canada
| | | | - N J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Canada; Community-Based Research Centre, Canada; University of Victoria, Canada
| | - R Nisenbaum
- Unity Health Toronto, Canada; University of Toronto, Canada
| | - G Ogilvie
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - C Sauvageau
- Université Laval, Canada; Institut national de santé publique du Québec, Canada
| | - D H S Tan
- Unity Health Toronto, Canada; University of Toronto, Canada
| | - A Yeung
- Unity Health Toronto, Canada
| | - A N Burchell
- Unity Health Toronto, Canada; University of Toronto, Canada.
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11
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Bolotin S, Tran V, Osman S, Brown KA, Buchan SA, Joh E, Deeks SL, Allen VG. SARS-CoV-2 Seroprevalence Survey Estimates Are Affected by Anti-Nucleocapsid Antibody Decline. J Infect Dis 2021; 223:1334-1338. [PMID: 33400794 PMCID: PMC7928877 DOI: 10.1093/infdis/jiaa796] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 09/28/2020] [Accepted: 01/04/2021] [Indexed: 02/02/2023] Open
Abstract
We analyzed 21 676 residual specimens from Ontario, Canada collected March-August 2020 to investigate the effect of antibody decline on SARS-CoV-2 seroprevalence estimates. Testing specimens orthogonally using Abbott (anti-nucleocapsid) and Ortho (anti-spike) assays, seroprevalence estimates were 0.4%-1.4%, despite ongoing disease activity. The geometric mean concentration (GMC) of antibody-positive specimens decreased over time (P = .015), and GMC of antibody-negative specimens increased over time (P = .0018). Association between the 2 tests decreased each month (P < .001), suggesting anti-nucleocapsid antibody decline. Lowering Abbott antibody index cutoff from 1.4 to 0.7 resulted in a 16% increase in positive specimens.
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Affiliation(s)
- Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Tran
- Public Health Ontario, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Selma Osman
- Public Health Ontario, Toronto, Ontario, Canada
| | - Kevin A Brown
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah A Buchan
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Joh
- Public Health Ontario, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa G Allen
- Public Health Ontario, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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12
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Righolt CH, Pabla G, Donelle J, Brna P, Deeks SL, Wilson SE, Smith B, Wilson K, Mahmud SM, Top KA, Hawken S. Vaccine coverage among children with epilepsy in two Canadian provinces: A Canadian immunization research network study. Vaccine 2021; 39:2117-2123. [PMID: 33722410 DOI: 10.1016/j.vaccine.2021.03.009] [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: 06/15/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Children with epilepsy are at increased risk of complications from vaccine-preventable infections, yet information on vaccine coverage in these children is scarce. We aimed to compare vaccine coverage among children with epilepsy to children without epilepsy. STUDY DESIGN We conducted a retrospective cohort study including all 2005-2013 births in Manitoba and Ontario, Canada, creating two cohorts: 2-year-olds and 7-year-olds (followed to age 2 and 7 years). We split each cohort into epilepsy and non-epilepsy subcohorts. We assessed vaccination coverage based on provincial schedules and determined timeliness of MMR (measles, mumps, rubella) dose 1 (recommended at 12 months) and DTaP (diphtheria, tetanus, pertussis) dose 4 (recommended at 18 months). We used logistic regression to calculate adjusted odds ratios (aORs) of the association between epilepsy and vaccination, combining both provincial estimates using random effects meta-analysis. RESULTS We included 16,558 2-year-olds (Manitoba, 653; Ontario, 15,905) and 13,004 7-year-olds (Manitoba, 483; Ontario, 12,521) with epilepsy. At age 2 years, the aOR for up-to-date vaccination among children with versus without epilepsy was 0.9 (95% confidence interval 0.8-1.1); at age 7 years it was 1.0 (0.9-1.1). Infants diagnosed with epilepsy before age 6 months were less likely to be up-to-date at age 2 years (0.9; 0.8-0.9), although this difference disappeared by age 7 years. Vaccine timeliness was similar between children with and without epilepsy for MMR dose 1 and DTaP dose 4. CONCLUSIONS Overall, this study suggests that children with epilepsy are not significantly under-vaccinated compared to their peers without epilepsy. As children with epilepsy are at a higher risk of complications from vaccine-preventable diseases, vaccination in children with epilepsy should be optimized, especially early in life, as these children may not be able to rely on herd protection.
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Affiliation(s)
- Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Gurpreet Pabla
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jessy Donelle
- Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Paula Brna
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada
| | | | - Bruce Smith
- Department of Mathematics and Statistics, Dalhousie University, Halifax, NS, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada; Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Steven Hawken
- Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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13
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Buchan SA, Daneman N, Wang J, Garber G, Wormsbecker AE, Wilson SE, Deeks SL. Incidence of Hospitalizations and Emergency Department Visits for Herpes Zoster in Immunocompromised and Immunocompetent Adults in Ontario, Canada, 2002-2016. Clin Infect Dis 2021; 71:22-29. [PMID: 31436814 DOI: 10.1093/cid/ciz769] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 05/17/2019] [Accepted: 08/20/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Immunocompromised adults are at .increased risk of herpes zoster (HZ) infection and related complications. We aimed to assess the incidence of hospital-attended HZ (ie, seen in hospital or emergency department) in immunocompromised populations and compare it to immunocompetent populations. METHODS We calculated incidence rates (IRs) of hospital-attended HZ in Ontario, Canada, between 1 April 2002 and 31 August 2016 in adults ≥18 years of age categorized as immunocompromised or immunocompetent. We repeated these analyses by type of immunocompromising condition and provided incidence rate ratios (IRRs) comparing to immunocompetent adults. We also calculated IRs and IRRs of HZ complications by immunocompromised status. RESULTS There were 135 206 incident cases of hospital-attended HZ during the study period. Immunocompromised adults accounted for 13% of these cases despite representing 3% of the population. The risk of hospital-attended HZ was higher for immunocompromised adults compared with immunocompetent adults (IRR, 2.9 [95% confidence interval {CI}, 2.9-3.0]) and ranged across type of immunocompromising conditions, from 2.6 (95% CI, 2.6-2.7) in those with a solid tumor malignancy to 12.3 (95% CI, 11.3-13.2) in those who had undergone hematopoietic stem cell transplant. The risk of any HZ complication was higher in immunocompromised adults (IRR, 3.6 [95% CI, 3.5-3.7]) and highest for disseminated zoster (IRR, 32.8 [95% CI, 27.8-38.6]). CONCLUSIONS The risk of hospital-attended HZ and related complications was higher in immunocompromised populations compared with immunocompetent populations. Our findings underscore the high-risk nature of this population and the potential benefits that may be realized through HZ vaccination.
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Affiliation(s)
- Sarah A Buchan
- Public Health Ontario, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Canada
| | - Nick Daneman
- Public Health Ontario, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada.,Sunnybrook Research Institute, Ontario, Canada.,Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Ontario, Canada.,Department of Medicine, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Jun Wang
- Public Health Ontario, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada
| | - Gary Garber
- Public Health Ontario, University of Toronto, Ontario, Canada.,Department of Medicine, Ontario, Canada.,Ottawa Hospital Research Institute, University of Toronto, Ontario, Canada.,Department of Medicine, University of Ottawa, Ontario, Canada
| | - Anne E Wormsbecker
- Unity Health Toronto, University of Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Sarah E Wilson
- Public Health Ontario, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Canada
| | - Shelley L Deeks
- Public Health Ontario, University of Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Canada
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14
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Buchan SA, Daneman N, Wang J, Wilson SE, Garber G, Wormsbecker AE, Antoniou T, Deeks SL. Herpes zoster in older adults in Ontario, 2002-2016: Investigating incidence and exploring equity. PLoS One 2021; 16:e0246086. [PMID: 33571224 PMCID: PMC7877748 DOI: 10.1371/journal.pone.0246086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/12/2021] [Indexed: 11/18/2022] Open
Abstract
Older adults are at increased risk of herpes zoster (HZ) and post-herpetic neuralgia (PHN) and HZ vaccines are available to help prevent infection. The objective of our study was to provide updated data on incidence of HZ and PHN related to clinical and demographic factors in older adults to inform immunization practices. We conducted a population-based, retrospective cohort study and included all cases of HZ seen in outpatient, emergency department, and hospital settings for adults aged 65 years and over between April 1, 2002 to August 31, 2016 in Ontario, Canada. We calculated the incidence of HZ and PHN, and estimated the proportion within each subgroup that developed PHN. We also assessed incidence by neighbourhood-level income quintile before and after the availability of vaccine for private purchase. The average annual incidence of HZ in any setting was 59.0 per 10,000 older adults, with higher incidence in outpatient as opposed to hospital settings. Incidence was higher in the oldest age groups, females, and those classified as immunocompromised or frail. Relative to the pre-vaccine era, the disparities in incidence of HZ by neighbourhood-level income increased, with higher rates of HZ and PHN seen in those residing in lower income quintiles. Additional prevention efforts should be targeted toward adults who are immunocompromised, frail, and those living in lower socioeconomic quintiles. Future work should assess the impact of the zoster vaccine program with a particular focus on equity in the publicly-funded era.
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Affiliation(s)
- Sarah A. Buchan
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Populations and Public Health, ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Nick Daneman
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Populations and Public Health, ICES, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jun Wang
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Populations and Public Health, ICES, Toronto, Ontario, Canada
| | - Sarah E. Wilson
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Populations and Public Health, ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gary Garber
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anne E. Wormsbecker
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tony Antoniou
- Populations and Public Health, ICES, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Health Protection, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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15
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Wilson SE, Bunko A, Johnson S, Murray J, Wang Y, Deeks SL, Crowcroft NS, Friedman L, Loh LC, MacLeod M, Taylor C, Li Y. The geographic distribution of un-immunized children in Ontario, Canada: Hotspot detection using Bayesian spatial analysis. Vaccine 2021; 39:1349-1357. [PMID: 33518467 DOI: 10.1016/j.vaccine.2020.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND In Ontario, Canada, little is currently known about the extent to which un-immunized children may cluster geographically. Our objectives were to: describe the geographic distribution of fully un-immunized children; identify geographic clusters (hotspots) of un-immunized children; and to characterize the contribution of spatial effects and covariates on hotspots, where found. METHODS Our analytic cohort consisted of Ontario students aged 7-17 years in the 2016-2017 school year. We defined students as un-immunized if they had zero doses of any vaccine and a non-medical exemption recorded in Ontario's registry. We calculated unadjusted proportions of un-immunized students by Census Subdivision (CSD) and then used a sequential approach to identify hotspots starting first with hotspot identification at the CSD level and then probed identified hotspots further by Dissemination Area (DA) and including covariates. Hotspots were identified using the Besag-York-Mollie Bayesian spatial model and were defined as areas with >95% probability of having two times the proportion of un-immunized students, relative to the province overall. RESULTS We identified 15,208 (0.94%) un-immunized children within our cohort consisting of more than 1.61 million students. Unadjusted proportions of un-immunized students varied greatly by geography, ranging from 0% to 21.5% by CSD. We identified 16 hotspot CSDs which clustered in five distinct areas, all of which were located in southern Ontario. The contribution of covariates and spatial effects on the risk of having un-immunized students varied greatly across hotspot areas. CONCLUSIONS Although the provincial proportion (0.94%) of un-immunized students is small, geographical clustering of such students is evident in Ontario and in some areas presents an important risk for future outbreaks. Further qualitative work within these hotspot areas would be a helpful next step to better characterize the factors associated with vaccine refusal in these communities.
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Affiliation(s)
- Sarah E Wilson
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; ICES, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
| | - Andrean Bunko
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada
| | - Steven Johnson
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada
| | - Jillian Murray
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada
| | - Yue Wang
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Shelley L Deeks
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Natasha S Crowcroft
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; ICES, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Lindsay Friedman
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada
| | - Lawrence C Loh
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Peel Public Health, 7120 Hurontario Street, Mississauga, Ontario L5W 1N4, Canada
| | - Melissa MacLeod
- Southwestern Public Health, 410 Buller Street, Woodstock, Ontario N4S 6G9, Canada
| | - Christina Taylor
- Huron Perth Public Health, 77722B London Road R.R. 5, Clinton, Ontario N0M 1L0, Canada
| | - Ye Li
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
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Ismail SJ, Zhao L, Tunis MC, Deeks SL, Quach C. Populations à immuniser en priorité contre la COVID-19 : Orientations préliminaires pour l’établissement de politiques. CMAJ 2020; 192:cmaj.202353-f. [PMID: 33203650 PMCID: PMC7721402 DOI: 10.1503/cmaj.202353-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Shainoor J Ismail
- Centre de l'immunisation et des maladies respiratoires infectieuses (Ismail, Zhao, Tunis), Agence de la santé publique du Canada, Ottawa, Ont.; Metro City Medical Clinic (Ismail), Edmonton, Alb.; Santé publique Ontario (Deeks); École Dalla Lana de santé publique (Deeks), Université de Toronto, Toronto, Ont.; Département de microbiologie, d'infectiologie et d'immunologie (Quach), Université de Montréal; Département de médecine de laboratoire clinique (Quach), CHU Sainte-Justine, Montréal, Qc
| | - Linlu Zhao
- Centre de l'immunisation et des maladies respiratoires infectieuses (Ismail, Zhao, Tunis), Agence de la santé publique du Canada, Ottawa, Ont.; Metro City Medical Clinic (Ismail), Edmonton, Alb.; Santé publique Ontario (Deeks); École Dalla Lana de santé publique (Deeks), Université de Toronto, Toronto, Ont.; Département de microbiologie, d'infectiologie et d'immunologie (Quach), Université de Montréal; Département de médecine de laboratoire clinique (Quach), CHU Sainte-Justine, Montréal, Qc
| | - Matthew C Tunis
- Centre de l'immunisation et des maladies respiratoires infectieuses (Ismail, Zhao, Tunis), Agence de la santé publique du Canada, Ottawa, Ont.; Metro City Medical Clinic (Ismail), Edmonton, Alb.; Santé publique Ontario (Deeks); École Dalla Lana de santé publique (Deeks), Université de Toronto, Toronto, Ont.; Département de microbiologie, d'infectiologie et d'immunologie (Quach), Université de Montréal; Département de médecine de laboratoire clinique (Quach), CHU Sainte-Justine, Montréal, Qc
| | - Shelley L Deeks
- Centre de l'immunisation et des maladies respiratoires infectieuses (Ismail, Zhao, Tunis), Agence de la santé publique du Canada, Ottawa, Ont.; Metro City Medical Clinic (Ismail), Edmonton, Alb.; Santé publique Ontario (Deeks); École Dalla Lana de santé publique (Deeks), Université de Toronto, Toronto, Ont.; Département de microbiologie, d'infectiologie et d'immunologie (Quach), Université de Montréal; Département de médecine de laboratoire clinique (Quach), CHU Sainte-Justine, Montréal, Qc
| | - Caroline Quach
- Centre de l'immunisation et des maladies respiratoires infectieuses (Ismail, Zhao, Tunis), Agence de la santé publique du Canada, Ottawa, Ont.; Metro City Medical Clinic (Ismail), Edmonton, Alb.; Santé publique Ontario (Deeks); École Dalla Lana de santé publique (Deeks), Université de Toronto, Toronto, Ont.; Département de microbiologie, d'infectiologie et d'immunologie (Quach), Université de Montréal; Département de médecine de laboratoire clinique (Quach), CHU Sainte-Justine, Montréal, Qc
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Affiliation(s)
- Shainoor J Ismail
- Centre for Immunization and Respiratory Infectious Diseases (Ismail, Zhao, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Metro City Medical Clinic (Ismail), Edmonton, Alta.; Public Health Ontario (Deeks); Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont.; Department of Microbiology, Infectious Diseases & Immunology (Quach), University of Montreal; Department of Clinical Laboratory Medicine (Quach), CHU Sainte-Justine, Montréal, Que
| | - Linlu Zhao
- Centre for Immunization and Respiratory Infectious Diseases (Ismail, Zhao, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Metro City Medical Clinic (Ismail), Edmonton, Alta.; Public Health Ontario (Deeks); Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont.; Department of Microbiology, Infectious Diseases & Immunology (Quach), University of Montreal; Department of Clinical Laboratory Medicine (Quach), CHU Sainte-Justine, Montréal, Que
| | - Matthew C Tunis
- Centre for Immunization and Respiratory Infectious Diseases (Ismail, Zhao, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Metro City Medical Clinic (Ismail), Edmonton, Alta.; Public Health Ontario (Deeks); Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont.; Department of Microbiology, Infectious Diseases & Immunology (Quach), University of Montreal; Department of Clinical Laboratory Medicine (Quach), CHU Sainte-Justine, Montréal, Que
| | - Shelley L Deeks
- Centre for Immunization and Respiratory Infectious Diseases (Ismail, Zhao, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Metro City Medical Clinic (Ismail), Edmonton, Alta.; Public Health Ontario (Deeks); Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont.; Department of Microbiology, Infectious Diseases & Immunology (Quach), University of Montreal; Department of Clinical Laboratory Medicine (Quach), CHU Sainte-Justine, Montréal, Que
| | - Caroline Quach
- Centre for Immunization and Respiratory Infectious Diseases (Ismail, Zhao, Tunis), Public Health Agency of Canada, Ottawa, Ont.; Metro City Medical Clinic (Ismail), Edmonton, Alta.; Public Health Ontario (Deeks); Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont.; Department of Microbiology, Infectious Diseases & Immunology (Quach), University of Montreal; Department of Clinical Laboratory Medicine (Quach), CHU Sainte-Justine, Montréal, Que
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Seo CY, Rashid M, Harris T, Stapleton J, Deeks SL. Assessing safety of Ontario’s publicly funded MMR and MMRV immunization programs, 2012 to 2016. Paediatr Child Health 2020; 25:358-364. [DOI: 10.1093/pch/pxz037] [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] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/19/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The combined measles, mumps, rubella (MMR) and measles, mumps, rubella, and varicella (MMRV) vaccines are part of Ontario’s routine immunization schedule.
Objective
To assess adverse events following immunization (AEFIs) reported in Ontario following administration of MMR and MMRV vaccines between 2012 and 2016.
Methods
Reports of AEFIs were extracted from the provincial surveillance database on May 9, 2017. Events were grouped by provincial surveillance definitions. Reporting rates were calculated using provincial population estimates or net doses distributed as the denominator. A serious AEFI is defined as an AEFI that resulted in an in-patient hospitalization or death.
Results
Overall, 289 AEFIs were reported following administration of MMR (n=246) or MMRV (n=43) vaccines, for annualized reporting rates of 16.6 and 8.8 reports per 100,000 distributed doses, respectively. The highest age-specific reporting rate was in children aged 1 to 3 years for MMR (7.7 per 100,000 population) and children aged 4 to 9 years for MMRV (0.8 per 100,000 population). Systemic reactions were the most frequently reported event category, while rash was the most frequently reported event for both vaccines. There were 22 serious AEFIs, 19 following MMR and 3 following MMRV (1.3 and 0.6 per 100,000 doses distributed, respectively).
Conclusions
Our assessment found a low reporting rate of adverse events following MMR and MMRV vaccines in Ontario. No safety concerns were identified. Our findings are consistent with the safety profiles of these vaccines. Continued monitoring of vaccine safety is necessary to maintain timely detection of unusual postvaccine events and public confidence in vaccine safety.
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Affiliation(s)
| | - Mohammed Rashid
- Public Health Ontario, Toronto, Ontario
- ICES, Toronto, Ontario
| | | | - Jody Stapleton
- Public Health Ontario, Toronto, Ontario
- Trillium Health Partners, Toronto, Ontario
| | - Shelley L Deeks
- Public Health Ontario, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
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Wilson SE, Wilton AS, Young J, Candido E, Bunko A, Buchan SA, Crowcroft NS, Deeks SL, Guttmann A, Halperin SA, Kwong JC, Wilson K, Tu K. Assessing the completeness of infant and childhood immunizations within a provincial registry populated by parental reporting: A study using linked databases in Ontario, Canada. Vaccine 2020; 38:5223-5230. [PMID: 32571722 DOI: 10.1016/j.vaccine.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In Ontario, Canada, parents have the responsibility to report their child's routine infant and childhood vaccines to the provincial immunization registry (the Digital Health Immunization Repository; DHIR) without healthcare provider validation. Despite its use in routine immunization coverage monitoring, no study has previously examined the completeness of immunization data within the DHIR. METHODS We assessed the completeness of DHIR immunizations, as compared to immunizations within the Electronic Medical Records-Primary Care (EMRPC) database, also known as EMRALD, a network of family physician electronic medical records (EMRs). We linked client records from the DHIR and EMRPC to a centralized population file. To create the study cohort, we examined children born during 2005-2008 and further defined the cohort based on those rostered to an EMRPC physician, visit criteria to ensure ongoing care by an EMRPC provider, and school attendance in Ontario at age 7. We calculated up-to-date (UTD) immunization coverage at age 7 for individual vaccines and overall using data from the DHIR and EMRPC separately, and compared the estimates. RESULTS The analytic cohort to assess DHIR data completeness included 2,657 children. Overall UTD coverage (all vaccines assessed) was 82.0% in the DHIR and 67.6% in EMRPC. UTD coverage was higher in the DHIR for all vaccines assessed individually, with the exception of meningococcal C conjugate vaccine (difference = 0.3%). After excluding two EMRPC sites with irregularities in immunization data, the difference in overall UTD coverage between systems decreased from 14.4% to 6.6% INTERPRETATION: These results validate the use of DHIR for coverage assessment but also suggest that bidirectional exchange of immunization information has the potential to increase immunization data completeness in both systems.
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Affiliation(s)
- Sarah E Wilson
- Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | - Sarah A Buchan
- Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Department of Pediatrics, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
| | - Kumanan Wilson
- ICES, Toronto, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Karen Tu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada; North York General Hospital, Toronto, Ontario, Canada
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Ramsay LC, Crowcroft NS, Thomas S, Aruffo E, Teslya A, Heffernan JM, Gournis E, Hiebert J, Jaeger V, Jiaravuthisan M, Sharron J, Severini A, Deeks SL, Gubbay J, Mazzulli T, Sander B. Cost-effectiveness of measles control during elimination in Ontario, Canada, 2015. ACTA ACUST UNITED AC 2020; 24. [PMID: 30892178 PMCID: PMC6425553 DOI: 10.2807/1560-7917.es.2019.24.11.1800370] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundGiven that measles is eliminated in Canada and measles immunisation coverage in Ontario is high, it has been questioned whether Ontario's measles outbreak response is worthwhile.AimOur objective was to determine cost-effectiveness of measles containment protocols in Ontario from the healthcare payer perspective.MethodsWe developed a decision-analysis model comparing Ontario's measles containment strategy (based on actual 2015 outbreak data) with a hypothetical 'modified response'. The modified scenario assumed 10% response costs with reduced case and contact tracing and no outbreak-associated vaccinations; it was based on local and provincial administrative and laboratory data and parameters from peer-reviewed literature. Short- and long-term health outcomes, quality-adjusted life years (QALYs) and costs discounted at 1.5%, were estimated. We conducted one- and two-way sensitivity analyses.ResultsThe 2015 outbreak in Ontario comprised 16 measles cases and an estimated 3,369 contacts. Predictive modelling suggested that the outbreak response prevented 16 outbreak-associated cases at a cost of CAD 1,213,491 (EUR 861,579). The incremental cost-effectiveness ratio was CAD 739,063 (EUR 524,735) per QALY gained for the outbreak response vs modified response. To meet the commonly accepted cost-effectiveness threshold of CAD 50,000 (EUR 35,500) per QALY gained, the outbreak response would have to prevent 94 measles cases. In sensitivity analyses, the findings were robust.ConclusionsOntario's measles outbreak response exceeds generally accepted cost-effectiveness thresholds and may not be the most efficient use of public health resources from a healthcare payer perspective. These findings should be balanced against benefits of increased vaccine coverage and maintaining elimination status.
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Affiliation(s)
- Lauren C Ramsay
- University Health Network, Eaton Building, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | | | | | | | | | - Effie Gournis
- Toronto Public Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Joanne Hiebert
- Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | | | | | | | - Alberto Severini
- University of Manitoba, Winnipeg, Manitoba, Canada.,Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Shelley L Deeks
- University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | | | - Tony Mazzulli
- University Health Network, Eaton Building, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Beate Sander
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,University Health Network, Eaton Building, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
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Dubé E, Wilson S, Gagnon D, Deeks SL, Dubey V. " It takes time to build trust": a survey Ontario's school-based HPV immunization program ten years post-implementation. Hum Vaccin Immunother 2020; 17:451-456. [PMID: 32643527 DOI: 10.1080/21645515.2020.1775456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Describe Ontario's school-based human papillomavirus (HPV) vaccination program from the perspective of local public health units (PHUs). METHODS In 2018, Vaccine Preventable Diseases (VPD) managers at each of Ontario's 35 PHUs were invited to participate in an online survey regarding the organization and delivery of their HPV vaccination program. Questions were asked on the school-based program, training and support of vaccine providers, communication and promotion, assessing coverage rates and perceptions of the program's strengths and challenges. Descriptive statistics were generated for close-ended items. A thematic content analysis was performed for open-ended items. RESULTS Eighteen PHUs (54%, n = 19/35) responded. All responding PHUs provided the HPV vaccine in publicly funded schools but only 6 reported being permitted to provide HPV vaccine in private schools. Fact sheets, Q&As or other written information locally developed by the PHUs were the main tools used to communicate with parents (n = 17), students (n = 13), school personnel (n = 13) and school board officials (n = 9). The most frequently reported barriers were: limited program resources, negative perceptions held by parents and/or school staff regarding the HPV vaccine, logistical issues (e.g., getting the consents forms returned, collaboration with schools for vaccine delivery) and the fact that HPV vaccination is not mandatory under Ontario legislation. CONCLUSION Local public health units that implement HPV vaccine programs in schools identified logistical barriers, public perceptions about the HPV vaccine and the voluntary nature of the program as the main barriers.
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Affiliation(s)
- Eve Dubé
- Département des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec (INSPQ) , Québec, Canada.,Axe Maladies infectieuses et immunitaires, Centre de Recherche du CHU de Québec-Université Laval , Québec, Canada.,Université Laval , Québec, Canada
| | - Sarah Wilson
- Department of Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Ontario, Canada.,Department of Clinical Public Health, Dalla Lana School of Public Health , Ontario, Canada.,ICES , Ontario, Canada
| | - Dominique Gagnon
- Département des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec (INSPQ) , Québec, Canada
| | - Shelley L Deeks
- Department of Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Ontario, Canada.,Department of Clinical Public Health, Dalla Lana School of Public Health , Ontario, Canada
| | - Vinita Dubey
- Department of Clinical Public Health, Dalla Lana School of Public Health , Ontario, Canada.,Toronto Public Health and the Canadian Immunization Research Network , Ontario, Canada
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22
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Wijayasri S, Hillier K, Lim GH, Harris TM, Wilson SE, Deeks SL. The shifting epidemiology and serotype distribution of invasive pneumococcal disease in Ontario, Canada, 2007-2017. PLoS One 2019; 14:e0226353. [PMID: 31834926 PMCID: PMC6910703 DOI: 10.1371/journal.pone.0226353] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background Ontario, Canada introduced a publicly-funded 13-valent pneumococcal conjugate vaccine (PCV13) for infants in 2010, replacing the 10-valent (PCV10, 2009–2010) and the 7-valent (PCV7, 2005–2009) conjugate vaccine programs; a 23-valent pneumococcal polysaccharide vaccine (PPV23) has been available for older adults since 1996. We examined the epidemiology and serotype distribution of invasive pneumococcal disease (IPD) in Ontario in the context of provincial immunization programs. Methods We included confirmed IPD cases reported in Ontario between 2007 and 2017. We grouped serotypes according to Ontario’s current immunization program (PCV13, PPV23, and non-vaccine-preventable) and calculated incidence rates (per 100,000 population) using population data. Results Between 2007 and 2017, annual incidence of IPD in Ontario ranged between 7.3 and 9.7/100,000 per year. Measures of illness severity were high throughout the period of surveillance. After PCV13 program implementation in 2010, incidence due to PCV13 serotypes decreased significantly across all age groups, with the greatest reductions in children <5 years and adults ≥65 years. Conversely, incidence due to PPV23 unique serotypes increased significantly between 2007 and 2017, with the greatest increases observed in adults 50–64 years (1.4 to 3.5/100,000) and ≥65 years (2.3 to 7.2/100,000). Similar increases were observed in incidence due to non-vaccine-preventable serotypes among all age groups, except infants <1 year. Within specific serotypes, incidence due to serotypes 3 (0.42 to 0.98/100,000) and 22F (0.31 to 0.72/100,000) increased significantly between 2007 and 2017, while incidence due to serotypes 19A and 7F decreased significantly during the PCV13 period (2010–2017). Conclusions Eight years after PCV13 implementation in Ontario, our data suggest both direct and indirect effects on serotype-specific incidence in young children and older adults. However, overall provincial rates have remained unchanged, and IPD continues to be a severe burden on the population. The rising incidence of IPD due to PPV23 unique and non-vaccine-preventable serotypes, and the growing burden of serotypes 3 and 22F, require further study.
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Affiliation(s)
- Shinthuja Wijayasri
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada
- * E-mail:
| | - Kelty Hillier
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada
| | - Gillian H. Lim
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada
| | - Tara M. Harris
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada
| | - Sarah E. Wilson
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Stapleton PJ, Eshaghi A, Seo CY, Wilson S, Harris T, Deeks SL, Bolotin S, Goneau LW, Gubbay JB, Patel SN. Evaluating the use of whole genome sequencing for the investigation of a large mumps outbreak in Ontario, Canada. Sci Rep 2019; 9:12615. [PMID: 31471545 PMCID: PMC6717193 DOI: 10.1038/s41598-019-47740-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/18/2019] [Indexed: 01/30/2023] Open
Abstract
In 2017 Ontario experienced the largest mumps outbreak in the province in 8 years, at a time when multiple outbreaks were occurring across North America. Of 259 reported cases, 143 occurred in Toronto, primarily among young adults. Routine genotyping of the small hydrophobic gene indicated that the outbreak was due to mumps virus genotype G. We performed a retrospective study of whole genome sequencing of 26 mumps virus isolates from early in the outbreak, using a tiling amplicon method. Results indicated that two of the cases were genetically divergent, with the remaining 24 cases belonging to two major clades and one minor clade. Phylogeographic analysis confirmed circulation of virus from each clade between Toronto and other regions in Ontario. Comparison with other genotype G strains from North America suggested that the presence of co-circulating major clades may have been due to separate importation events from outbreaks in the United States. A transmission network analysis performed with the software program TransPhylo was compared with previously collected epidemiological data. The transmission tree correlated with known epidemiological links between nine patients and identified new potential clusters with no known epidemiological links.
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Affiliation(s)
- P J Stapleton
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
| | - A Eshaghi
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
| | - C Y Seo
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
| | - S Wilson
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - T Harris
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
| | - S L Deeks
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - S Bolotin
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Immunisation Research and Evaluation, Public Health Ontario, Toronto, ON, Canada
| | - L W Goneau
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
| | - J B Gubbay
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
| | - S N Patel
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada.
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Bolotin S, Severini A, Hatchette T, McLachlan E, Savage R, Hughes SL, Wang J, Deeks SL, Wilson S, Brisson M, Halperin SA, Gubbay J, Mazzulli T, Serhir B, Ward BJ, Crowcroft N. Assessment of population immunity to measles in Ontario, Canada: a Canadian Immunization Research Network (CIRN) study. Hum Vaccin Immunother 2019; 15:2856-2864. [PMID: 31184979 PMCID: PMC6930091 DOI: 10.1080/21645515.2019.1619402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Canada eliminated measles in 1998. We conducted a sero-epidemiology study to estimate population immunity to measles in the province of Ontario, Canada and to identify groups at higher risk of outbreaks. We used a previously developed modified enzyme immunoassay to test 1,199 residual sera from patients aged 1–39 years. We re-tested negative and equivocal sera using a plaque reduction neutralization assay. We interpreted our results in the context of Ontario’s immunization program and vaccine coverage data. Of 1,199 sera, 1035 (86.3%, 95% confidence interval (CI) 84.4, 88.2) were above the measles threshold for protection, 70 (5.8%, 95% CI 4.5, 7.2) were equivocal and 94 (7.8%, 95% CI 6.3, 9.4) were negative. The proportion of positive sera was highest for those 1–5 years, with 180/199 (90.5%, 95% CI 86.4, 94.5) positive sera, and lowest for those age 12–19 years, at 158/199 (79.4%, 95% CI 73.8, 85.0). Adjusted for age, females were more likely than males to have antibody titers above the threshold of protection (odds ratio = 1.60, 95% CI 1.14, 2.24). Most of the study cohort were eligible for two measles vaccine doses, and vaccine uptake in Ontario is >90% for school-aged cohorts. We observed a higher than expected proportion of sera with antibody levels below the threshold of protection, suggesting that immunity in some Ontario age-groups may be waning, despite high vaccine coverage. Alternatively, the traditional measles correlates of protection may not be an appropriate measure of population protection in measles-eliminated settings.
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Affiliation(s)
- Shelly Bolotin
- Public Health Ontario, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alberto Severini
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Todd Hatchette
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Elizabeth McLachlan
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | | | | | - John Wang
- Public Health Ontario, Toronto, ON, Canada
| | - Shelley L Deeks
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah Wilson
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Marc Brisson
- Département de médecine sociale et préventive, Université Laval, Québec City, QC, Canada
| | - Scott A Halperin
- Department of Pathology, Dalhousie University, Halifax, NS, Canada.,Canadian Center for Vaccinology, IWK Health Centre, Halifax, NS, Canada
| | - Jonathan Gubbay
- Public Health Ontario, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Tony Mazzulli
- Public Health Ontario, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Microbiology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Bouchra Serhir
- Laboratoire de santé publique du Québec/Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, QC, Canada
| | - Brian J Ward
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Natasha Crowcroft
- Public Health Ontario, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
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25
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Wilson SE, Murray J, Bunko A, Johnson S, Buchan SA, Crowcroft NS, Dubey V, Loh LC, MacLeod M, Taylor C, Deeks SL. Characteristics of immunized and un-immunized students, including non-medical exemptions, in Ontario, Canada: 2016–2017 school year. Vaccine 2019; 37:3123-3132. [DOI: 10.1016/j.vaccine.2019.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
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26
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Wilson SE, Rosella LC, Wang J, Renaud A, Le Saux N, Crowcroft NS, Desai S, Harris T, Bolotin S, Gubbay J, Deeks SL. Equity and impact: Ontario's infant rotavirus immunization program five years following implementation. A population-based cohort study. Vaccine 2019; 37:2408-2414. [PMID: 30765171 DOI: 10.1016/j.vaccine.2019.01.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/18/2019] [Accepted: 01/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ontario implemented a publicly-funded rotavirus (RV) immunization program in 2011. Our objectives were to evaluate its impact on hospitalizations and emergency department (ED) visits for acute gastroenteritis (AGE) five years after implementation. METHODS We performed a population-based longitudinal retrospective cohort study to identify hospitalizations and ED visits for RV-AGE and overall AGE in all age groups using ICD-10 codes between August 1, 2005 and March 31, 2016. A negative binomial regression model that included the effect of time was used to calculate rates, rate ratios (RRs) and 95% confidence intervals (CIs) for AGE before and after the program's implementation, after adjusting for age, seasonality and secular trends. We examined the seasonality of RV-AGE hospitalizations among children under five before and after the program and explored its equity impact. RESULTS Following program implementation, RV-AGE hospitalizations and ED visits among children under five years declined by 76% (RR 0.24, 95% CI 0.20-0.28) and 68% (RR 0.32, 95% CI 0.21-0.50), respectively. In addition, hospitalizations and ED visits for overall AGE declined by 38% (RR 0.62, 95% CI 0.59-0.65) and 26% (RR 0.74, 95% CI 0.73-0.76), respectively, among children under age five. Significant reductions in both outcomes were also found across a range of age-strata. In the pre-program period, the mean monthly hospitalization rate for RV-AGE among children residing in the most marginalized neighbourhoods was 33% higher than those residing in the least marginalized (RR 1.33, 95% CI 1.17-1.52), this disparity was not evident in the program period (RR 0.95, 95% CI 0.69-1.32). We found no evidence of a seasonal shift in rotavirus pediatric hospitalizations. INTERPRETATION The introduction of routine infant rotavirus immunization has had a substantial population impact in Ontario. Our study confirms herd effects and suggests the program may have reduced previous inequities in the burden of pediatric rotavirus hospitalizations.
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Affiliation(s)
- Sarah E Wilson
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Laura C Rosella
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jun Wang
- Public Health Ontario, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Nicole Le Saux
- Division of Infectious Disease, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ontario, Canada
| | - Natasha S Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Shalini Desai
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Tara Harris
- Public Health Ontario, Toronto, Ontario, Canada
| | - Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Gubbay
- Public Health Ontario, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Wormsbecker AE, Johnson C, Bourns L, Harris T, Crowcroft NS, Deeks SL. Demonstration of background rates of three conditions of interest for vaccine safety surveillance. PLoS One 2019; 14:e0210833. [PMID: 30645649 PMCID: PMC6333343 DOI: 10.1371/journal.pone.0210833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/02/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Adverse events following immunization (AEFIs) are unwanted or unexpected health outcomes following vaccination, which may or may not be causally-linked to vaccines. AEFI reporting is important to post-marketing vaccine safety surveillance and has the potential to identify new or rare AEFIs, show increases in known AEFIs, and help to maintain public confidence in vaccine programs. Knowledge of the expected incidence (i.e. background rate) of a possible AEFI is essential to the investigation of vaccine safety signals. We selected three rarely reported AEFIs representing the spectrum of causal association with vaccines, from proven (immune thrombocytopenia [ITP]) to questioned (Kawasaki disease [KD]) to unsubstantiated (multiple sclerosis [MS]) and determined their background rates. METHODS We extracted data on hospitalizations (CIHI Discharge Abstract Database) for ITP, KD, and MS among Ontario children for the period 2005 to 2014 from IntelliHEALTH. As ITP can be managed without hospitalization, we also extracted emergency department (ED) visits from the CIHI National Ambulatory Care Reporting System. For all conditions, we only counted the first visit and if the same child had both an ED visit and a hospitalization for ITP, only the hospitalization was included. We calculated rates by year, age group and sex using population estimates from 2005-2014, focusing on age groups within the Ontario immunization schedule around vaccine(s) of interest. RESULTS Per 100,000 population, annual age-specific incidence of ITP in children age 1 to 7 years ranged from 8.9 to 12.2 and annual incidence of KD in children less than 5 years ranged from 19.1 to 32.1. Average annualized incidence of adolescent (11-17 years) MS across the study period was 0.8 per 100,000. DISCUSSION Despite limitations, including lack of clinical validation, this study provides an example of how health administrative data can be used to determine background rates which may assist with interpretation of passive vaccine safety surveillance.
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Affiliation(s)
- Anne E. Wormsbecker
- St. Joseph’s Health Centre, Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Laura Bourns
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tara Harris
- Public Health Ontario, Toronto, Ontario, Canada
| | - Natasha S. Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Wilson K, Duque DR, Murphy MS, Hawken S, Pham-Huy A, Kwong J, Deeks SL, Potter BK, Crowcroft NS, Bulman DE, Chakraborty P, Little J. T-cell receptor excision circle levels and safety of paediatric immunization: A population-based self-controlled case series analysis. Hum Vaccin Immunother 2018; 14:1378-1391. [PMID: 29420131 PMCID: PMC6037463 DOI: 10.1080/21645515.2018.1433971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/09/2018] [Accepted: 01/20/2018] [Indexed: 12/21/2022] Open
Abstract
T-cell receptor excision circle levels are a surrogate marker of T-cell production and immune system function. We sought to determine whether non-pathological levels of infant T-cell receptor excision circles were associated with adverse events following immunization. A self-controlled case series design was applied on a sample of 231,693 children who completed newborn screening for severe combined immunodeficiency in Ontario, Canada between August 2013 and December 2015. Exposures included routinely administered pediatric vaccines up to 15 months of age. Main outcomes were combined health services utilization for recognized adverse events following immunization. 1,406,981 vaccination events were included in the final dataset. 103,007 children received the Pneu-C-13 or Men-C-C vaccine and 97,998 received the MMR vaccine at 12 months of age. 67,725 children received the varicella immunization at 15 months. Our analysis identified no association between newborn T-cell receptor excision circle levels and subsequent health services utilization events following DTa-IPV-Hib, Pneu-C-13, and Men-C-C vaccinations at 2-month (RI 0.94[95%CI 0.87-1.02]), 4-month (RI 0.82[95%CI 0.75-0.9]), 6-month (RI 0.63[95%CI 0.57-0.7]) and 12-month (RI 0.49[95%CI 0.44-0.55]). We also found no trends in health services utilization following MMR (RI 1.43[95%1.34-1.52]) or varicella (RI 1.14[95%CI 1.05-1.23]) vaccination. Our findings provide further support for the safety of pediatric vaccinations.
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Affiliation(s)
- Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Malia S.Q Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Anne Pham-Huy
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Jeffrey Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Shelley L. Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Beth K. Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | | | - Pranesh Chakraborty
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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29
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Burgess K, Atkinson KM, Westeinde J, Crowcroft N, Deeks SL, Wilson K. Barriers and facilitators to the use of an immunization application: a qualitative study supplemented with Google Analytics data. J Public Health (Oxf) 2018; 39:e118-e126. [PMID: 27247122 DOI: 10.1093/pubmed/fdw032] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Barriers and facilitators of mobile app adoption are not known. This study examined usage of a new Pan-Canadian immunization app to identify factors that contributed to usage. Methods Women in their third trimester of pregnancy or had given birth in the previous 3 months were recruited from a hospital obstetrical unit. Fifty-five participants were instructed to download the ImmunizeCA app. After at least 6 months, 10 interviews were conducted, transcribed and coded. Themes identified were compared with aggregate ImmunizeCA usage data (n = 74 212 users). Results Facilitators included features that address logistical challenges, improved convenience and information access. Barriers included absence of system integration. Concerns regarding the privacy and security of personal health information were not an inhibitor as long as best practices are followed. Google Analytics data on usage supported qualitative findings. Conclusion Future studies should evaluate the quantitative impact of factors we identified on app uptake and usage. Subsequent mobile app studies may benefit from the use of analytic data as they were found to be effective in helping to validate qualitative data derived from interviews with study participants.
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Affiliation(s)
- Kathleen Burgess
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, CanadaK1Y 4E9
| | - Katherine M Atkinson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada K1Y 4E9.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jacqueline Westeinde
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, CanadaK1Y 4E9
| | - Natasha Crowcroft
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Shelley L Deeks
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada K1Y 4E9.,Department of Medicine, University of Ottawa, Ottawa, Canada.,Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
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Crowcroft NS, Johnson C, Chen C, Li Y, Marchand-Austin A, Bolotin S, Schwartz K, Deeks SL, Jamieson F, Drews S, Russell ML, Svenson LW, Simmonds K, Mahmud SM, Kwong JC. Under-reporting of pertussis in Ontario: A Canadian Immunization Research Network (CIRN) study using capture-recapture. PLoS One 2018; 13:e0195984. [PMID: 29718945 PMCID: PMC5931792 DOI: 10.1371/journal.pone.0195984] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/03/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Under-reporting of pertussis cases is a longstanding challenge. We estimated the true number of pertussis cases in Ontario using multiple data sources, and evaluated the completeness of each source. Methods We linked data from multiple sources for the period 2009 to 2015: public health reportable disease surveillance data, public health laboratory data, and health administrative data (hospitalizations, emergency department visits, and physician office visits). To estimate the total number of pertussis cases in Ontario, we used a three-source capture-recapture analysis stratified by age (infants, or aged one year and older) and adjusting for dependency between sources. We used the Bayesian Information Criterion to compare models. Results Using probable and confirmed reported cases, laboratory data, and combined hospitalizations/emergency department visits, the estimated total number of cases during the six-year period amongst infants was 924, compared with 545 unique observed cases from all sources. Using the same sources, the estimated total for those aged 1 year and older was 12,883, compared with 3,304 observed cases from all sources. Only 37% of infants and 11% for those aged 1 year and over admitted to hospital or seen in an emergency department for pertussis were reported to public health. Public health reporting sensitivity varied from 2% to 68% depending on age group and the combination of data sources included. Sensitivity of combined hospitalizations and emergency department visits varied from 37% to 49% and of laboratory data from 1% to 50%. Conclusions All data sources contribute cases and are complementary, suggesting that the incidence of pertussis is substantially higher than suggested by routine reports. The sensitivity of different data sources varies. Better case identification is required to improve pertussis control in Ontario.
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Affiliation(s)
- Natasha S. Crowcroft
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- * E-mail:
| | | | | | - Ye Li
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Shelly Bolotin
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kevin Schwartz
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shelley L. Deeks
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Frances Jamieson
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Steven Drews
- ProvLab Alberta, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | | | - Lawrence W. Svenson
- Alberta Health, Edmonton, AB, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kimberley Simmonds
- Alberta Health, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Salaheddin M. Mahmud
- Vaccine and Drug Evaluation Centre, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jeffrey C. Kwong
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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31
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Thomas S, Hiebert J, Gubbay JB, Gournis E, Sharron J, Severini A, Jiaravuthisan M, Shane A, Jaeger V, Crowcroft NS, Fediurek J, Sander B, Mazzulli T, Schulz H, Deeks SL. Measles Outbreak with Unique Virus Genotyping, Ontario, Canada, 2015. Emerg Infect Dis 2018. [PMID: 28628461 PMCID: PMC5512469 DOI: 10.3201/eid2307.161145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The province of Ontario continues to experience measles virus transmissions despite the elimination of measles in Canada. We describe an unusual outbreak of measles in Ontario, Canada, in early 2015 that involved cases with a unique strain of virus and no known association among primary case-patients. A total of 18 cases of measles were reported from 4 public health units during the outbreak period (January 25–March 23, 2015); none of these cases occurred in persons who had recently traveled. Despite enhancements to case-patient interview methods and epidemiologic analyses, a source patient was not identified. However, the molecular epidemiologic analysis, which included extended sequencing, strongly suggested that all cases derived from a single importation of measles virus genotype D4. The use of timely genotype sequencing, rigorous epidemiologic investigation, and a better understanding of the gaps in surveillance are needed to maintain Ontario’s measles elimination status.
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Isabel S, Higgins RR, Peci A, Isabel MR, Deeks SL, Gubbay JB. Rotavirus genotypes circulating in Ontario, Canada, before and after implementation of the rotavirus immunization program. Vaccine 2018. [PMID: 29526372 DOI: 10.1016/j.vaccine.2018.02.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Ontario introduced a universal publicly-funded group A rotavirus (RVA) immunization program in August 2011, using monovalent vaccine. RVA immunization programs have decreased the incidence of RVA acute gastroenteritis in many countries but it is unclear if it will contribute to the emergence of certain genotypes. We monitored RVA trends and genotypes in Ontario before and after implementation of the publicly-funded immunization program. METHODS RVA detection was conducted at Public Health Ontario Laboratories from January 2009 to December 2011 (pre-program period) and January 2012 to October 2015 (publicly-funded RVA immunization program period) and number of RVA-positive specimens and percent positivity were analysed. A convenience sample of RVA-positive stool specimens, from September 2010 to December 2011 (pre-program period) and January 2012 to June 2013 (program period), were genotyped using heminested PCR. A literature review on the burden of illness from emergent genotype was performed. RESULTS Stool specimens showed a significant decrease in RVA percent positivity from the 36 month pre-program period (14.4%; 1537/10700) to the 46 month program period (6.1%; 548/9019). An increase in the proportion of RVA G10 among genotyped specimens, associated with five different P genotypes, from the pre-program (6.3%; 13/205) to the program (31.5%; 40/127) period was observed. Our literature review identified approximately 200 G10-positive human stool specimens from 16 different countries. CONCLUSIONS This study documented a decrease in the number of RVA-positive specimens and percent positivity after implementation of the immunization program. An unexpected increase in the proportion of RVA G10 was detected following program introduction. Ongoing RVA surveillance is important in evaluating both the long-term impact of immunization and emergence of RVA genotypes.
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Affiliation(s)
- Sandra Isabel
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Marc R Isabel
- Département de géomatique, Université Laval, Québec, Québec, Canada
| | - Shelley L Deeks
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan B Gubbay
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
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Wilson SE, Chung H, Schwartz KL, Guttmann A, Deeks SL, Kwong JC, Crowcroft NS, Wing L, Tu K. Rotavirus vaccine coverage and factors associated with uptake using linked data: Ontario, Canada. PLoS One 2018; 13:e0192809. [PMID: 29444167 PMCID: PMC5812625 DOI: 10.1371/journal.pone.0192809] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 01/30/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In August 2011, Ontario, Canada introduced a rotavirus immunization program using Rotarix™ vaccine. No assessments of rotavirus vaccine coverage have been previously conducted in Ontario. METHODS We assessed vaccine coverage (series initiation and completion) and factors associated with uptake using the Electronic Medical Record Administrative data Linked Database (EMRALD), a collection of family physician electronic medical records (EMR) linked to health administrative data. Series initiation (1 dose) and series completion (2 doses) before and after the program's introduction were calculated. To identify factors associated with series initiation and completion, adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated using logistic regression. RESULTS A total of 12,525 children were included. Series completion increased each year of the program (73%, 79% and 84%, respectively). Factors associated with series initiation included high continuity of care (aOR = 2.15; 95%CI, 1.61-2.87), maternal influenza vaccination (aOR = 1.55; 95%CI,1.24-1.93), maternal immmigration to Canada in the last five years (aOR = 1.47; 95% CI, 1.05-2.04), and having no siblings (aOR = 1.62; 95%CI,1.30-2.03). Relative to the first program year, infants were more likely to initiate the series in the second year (aOR = 1.71; 95% CI 1.39-2.10) and third year (aOR = 2.02; 95% CI 1.56-2.61) of the program. Infants receiving care from physicians with large practices were less likely to initiate the series (aOR 0.91; 95%CI, 0.88-0.94, per 100 patients rostered) and less likely to complete the series (aOR 0.94; 95%CI, 0.91-0.97, per 100 patients rostered). Additional associations were identified for series completion. CONCLUSIONS Family physician delivery achieved moderately high coverage in the program's first three years. This assessment demonstrates the usefulness of EMR data for evaluating vaccine coverage. Important insights into factors associated with initiation or completion (i.e. high continuity of care, smaller roster sizes, rural practice location) suggest areas for research and potential program supports.
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Affiliation(s)
- Sarah E. Wilson
- Public Health Ontario, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hannah Chung
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Kevin L. Schwartz
- Public Health Ontario, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey C. Kwong
- Public Health Ontario, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natasha S. Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Laura Wing
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Karen Tu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Johnson C, Chen C, Rosella L, Rilkoff H, Marchand-Austin A, Gubbay JB, Kozlowski T, Deeks SL, Mazzulli T, Crowcroft N. Limitations of administrative data to identify measles cases in Ontario, Canada: a cautionary tale. Can J Public Health 2018; 109:3-7. [PMID: 29981059 PMCID: PMC6964602 DOI: 10.17269/s41997-018-0021-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 10/28/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore the utility of laboratory data and determine the validity of healthcare administrative data for describing the frequency of measles in Ontario. METHODS We linked Ontario healthcare utilization administrative data to Public Health Ontario (PHO) laboratory data from 01 January 2006 to 30 November 2012. RESULTS The sensitivity of the administrative data was 54% and the positive predictive value was 1% when compared with 50 cases identified in laboratory data as a gold standard. CONCLUSIONS As measles is no longer endemic in Ontario, the high number of measles-coded healthcare visits found in Ontario health administration data exceeds the true number of cases. Great caution should be taken in using administrative data to calculate the incidence of measles in areas where it has been eliminated.
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Affiliation(s)
- Caitlin Johnson
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
| | - Cynthia Chen
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Laura Rosella
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Heather Rilkoff
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Alex Marchand-Austin
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Tina Kozlowski
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Shelley L Deeks
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Tony Mazzulli
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Natasha Crowcroft
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Bolotin S, Johnson C, Quach S, Ambrose A, DeCoutere S, Deeks SL, Drews S, Faheem A, Green K, Halperin SA, Hoang L, Jamieson F, Kollmann T, Marchand-Austin A, McCormack D, McGeer A, Murti M, Bba AO, Rebbapragada A, Vanderkooi OG, Wang J, Warshawsky B, Crowcroft NS. Case-control study of household contacts to examine immunological protection from Bordetella pertussis transmission - study protocol. CMAJ Open 2017; 5:E872-E877. [PMID: 29269437 PMCID: PMC5741426 DOI: 10.9778/cmajo.20170072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is mounting evidence that the recent resurgence of pertussis in many countries is in part related to the acellular vaccine, which has been administered in Canada since 1997. This vaccine elicits a different cell-mediated immune response than the previously used whole-cell vaccine, and its effectiveness wanes over time. The aim of this study is to understand the immunological, demographic and clinical factors that mediate protection from pertussis on exposure. METHODS This is a household case-control study protocol. Following notification of an index case in a household, a study team will conduct a home visit to collect data and biological specimens. The study team will return to the household 8 weeks from the onset of illness in the index case. The Th1, Th2 and Th17 responses, cytokine expression, IgG subclass, blood cell counts and presence of Bordetella pertussis will be determined. We will use laboratory and statistical analyses to determine immunological differences between contacts who are infected with B. pertussis and contacts who remain healthy, and to determine which clinical and demographic covariates are associated with a reduced risk of infection. INTERPRETATION The results of this study will be essential for understanding the immune response required for protection from infection with B. pertussis and will contribute to our understanding of the shortcomings of the current vaccine.
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Affiliation(s)
- Shelly Bolotin
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Caitlin Johnson
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Susan Quach
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Ardith Ambrose
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Sarah DeCoutere
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Shelley L Deeks
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Steven Drews
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Amna Faheem
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Karen Green
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Scott A Halperin
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Linda Hoang
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Frances Jamieson
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Tobias Kollmann
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Alex Marchand-Austin
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Deirdre McCormack
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Allison McGeer
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Michelle Murti
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Alison Orth Bba
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Anu Rebbapragada
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Otto G Vanderkooi
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Jun Wang
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Bryna Warshawsky
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
| | - Natasha S Crowcroft
- Affiliations: Public Health Ontario (Bolotin, Johnson, Quach, Deeks, Jamieson, Marchand-Austin, Warshawsky, Crowcroft); University of Toronto (Bolotin, Deeks, Jamieson, Crowcroft), Toronto, Ont.; Canadian Center for Vaccinology (Ambrose, DeCoutere, Halperin, Wang), Halifax, NS; Department of Laboratory Medicine and Pathology (Drews), University of Alberta; ProvLab Alberta (Drews), Edmonton, Alta.; North York General Hospital (Faheem); Mount Sinai Hospital (Green, McGeer), Toronto, Ont.; Department of Microbiology and Immunology (Halperin), Dalhousie University, Halifax, NS; British Columbia Centre for Disease Control (Hoang); Child and Family Research Institute (Kollmann), Vancouver, BC; McGill University Health Centre (McCormack), Montréal, Que.; Fraser Health Authority (Murti, Orth), Surrey, BC; Gamma Dynacare (Rebbapragada), Brampton, Ont.; University of Calgary (Vanderkooi), Calgary, Alta
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Guerra FM, Bolotin S, Lim G, Heffernan J, Deeks SL, Li Y, Crowcroft NS. The basic reproduction number (R 0 ) of measles: a systematic review. The Lancet Infectious Diseases 2017; 17:e420-e428. [DOI: 10.1016/s1473-3099(17)30307-9] [Citation(s) in RCA: 270] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 03/10/2017] [Accepted: 03/23/2017] [Indexed: 01/07/2023]
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Ismail SJ, Deeks SL. Human papillomavirus vaccines. CMAJ 2017; 189:E1212. [PMID: 28947547 PMCID: PMC5621933 DOI: 10.1503/cmaj.150465] [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] [Indexed: 11/01/2022] Open
Affiliation(s)
- Shainoor J Ismail
- Centre for Immunization and Respiratory Infectious Diseases (Ismail), Public Health Agency of Canada, Ottawa, Ont.; Metro City Medical Clinic (Ismail); Immunization and Vaccine Preventable Diseases (Deeks), Public Health Ontario; Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont.
| | - Shelley L Deeks
- Centre for Immunization and Respiratory Infectious Diseases (Ismail), Public Health Agency of Canada, Ottawa, Ont.; Metro City Medical Clinic (Ismail); Immunization and Vaccine Preventable Diseases (Deeks), Public Health Ontario; Dalla Lana School of Public Health (Deeks), University of Toronto, Toronto, Ont
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Wilson SE, Quach S, MacDonald SE, Naus M, Deeks SL, Crowcroft NS, Mahmud SM, Tran D, Kwong J, Tu K, Gilbert NL, Johnson C, Desai S. Methods used for immunization coverage assessment in Canada, a Canadian Immunization Research Network (CIRN) study. Hum Vaccin Immunother 2017; 13:1928-1936. [PMID: 28708945 PMCID: PMC5557229 DOI: 10.1080/21645515.2017.1319022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Accurate and complete immunization data are necessary to assess vaccine coverage, safety and effectiveness. Across Canada, different methods and data sources are used to assess vaccine coverage, but these have not been systematically described. Our primary objective was to examine and describe the methods used to determine immunization coverage in Canada. The secondary objective was to compare routine infant and childhood coverage estimates derived from the Canadian 2013 Childhood National Immunization Coverage Survey (cNICS) with estimates collected from provinces and territories (P/Ts). We collected information from key informants regarding their provincial, territorial or federal methods for assessing immunization coverage. We also collected P/T coverage estimates for select antigens and birth cohorts to determine absolute differences between these and estimates from cNICS. Twenty-six individuals across 16 public health organizations participated between April and August 2015. Coverage surveys are conducted regularly for toddlers in Quebec and in one health authority in British Columbia. Across P/Ts, different methodologies for measuring coverage are used (e.g., valid doses, grace periods). Most P/Ts, except Ontario, measure up-to-date (UTD) coverage and 4 P/Ts also assess on-time coverage. The degree of concordance between P/T and cNICS coverage estimates varied by jurisdiction, antigen and age group. In addition to differences in the data sources and processes used for coverage assessment, there are also differences between Canadian P/Ts in the methods used for calculating immunization coverage. Comparisons between P/T and cNICS estimates leave remaining questions about the proportion of children fully vaccinated in Canada.
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Affiliation(s)
- Sarah E Wilson
- a Public Health Ontario , Toronto , Ontario , Canada.,b Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada.,c Institute for Clinical Evaluative Services , Toronto , Ontario , Canada
| | - Susan Quach
- a Public Health Ontario , Toronto , Ontario , Canada
| | | | - Monika Naus
- e BC Centre for Disease Control , Vancouver , British Columbia , Canada.,f School of Population and Public Health, University of British Columbia , Vancouver , British Columbia , Canada
| | - Shelley L Deeks
- a Public Health Ontario , Toronto , Ontario , Canada.,b Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada
| | - Natasha S Crowcroft
- a Public Health Ontario , Toronto , Ontario , Canada.,b Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada.,g Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , Ontario , Canada
| | - Salaheddin M Mahmud
- h Department of Community Health Sciences , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Dat Tran
- i The Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada
| | - Jeff Kwong
- a Public Health Ontario , Toronto , Ontario , Canada.,b Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada.,c Institute for Clinical Evaluative Services , Toronto , Ontario , Canada.,j Department of Family and Community Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Karen Tu
- c Institute for Clinical Evaluative Services , Toronto , Ontario , Canada.,j Department of Family and Community Medicine , University of Toronto , Toronto , Ontario , Canada.,k Institute of Health Policy Management and Evaluation, University of Toronto , Toronto , Ontario , Canada
| | | | | | - Shalini Desai
- l Public Health Agency of Canada , Ottawa , Ontario , Canada
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Harris T, Nair J, Fediurek J, Deeks SL. Assessment of sex-specific differences in adverse events following immunization reporting in Ontario, 2012-15. Vaccine 2017; 35:2600-2604. [PMID: 28365252 DOI: 10.1016/j.vaccine.2017.03.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 02/01/2017] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 11/17/2022]
Abstract
We assessed sex-specific trends within passive vaccine safety surveillance in Ontario, Canada. AEFIs reported following vaccines administered between 2012 and 2015 were included. There were 2466 AEFI reports; 66.2% were female. Annualized reporting rates were 5.9 and 3.1 per 100,000 population, for females and males respectively. The female:male reporting rate ratio (RRR) was 1.9. Sex-specific differences by age group were greatest in adults 18-64years (RRR 6.3); whereas there were no differences in children <10years. Vaccine-specific RRRs were highest for vaccines recommended for routine use in adults or high risk populations. All event categories were female-predominant. The highest event-specific RRRs were for oculorespiratory syndrome (5.1), anaesthesia/paraesthesia (4.6) and anaphylaxis (3.0). Serious AEFIs (n=113) were more evenly distributed (57.5% female, RRR 1.3) than non-serious (66.6% female, RRR 1.9). AEFI reporting among females was consistently elevated within the passive surveillance system in Ontario. Further study of the relationship between sex/gender and AEFI reporting is needed.
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Affiliation(s)
- Tara Harris
- Public Health Ontario, Toronto, Ontario, Canada.
| | | | | | - Shelley L Deeks
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Hawken S, Ducharme R, Rosella LC, Benchimol EI, Langley JM, Wilson K, Crowcroft NS, Halperin SA, Desai S, Naus M, Sanford CJ, Mahmud SM, Deeks SL. Assessing the risk of intussusception and rotavirus vaccine safety in Canada. Hum Vaccin Immunother 2017; 13:703-710. [PMID: 27835525 PMCID: PMC5360150 DOI: 10.1080/21645515.2016.1240846] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/27/2016] [Accepted: 09/20/2016] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Intussusception has been identified as a rare adverse event following rotavirus immunization. We sought to determine the incidence of intussusception among infants in Canada both before and after introduction of rotavirus immunization programs. METHODS We used Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD) to identify infants under 1 y of age who were admitted to a Canadian hospital, which the exception of Quebec, which does not submit data to CIHI, with a diagnosis of intussusception (ICD-10 code K56.1, and ICD-9 code 560) between January 1st, 2003 and December 31, 2013. We compared rates of intussusception hospitalization before and after rotavirus vaccine program introduction. Rates were adjusted for calendar year, age (in months), sex and region using Poisson regression models. Denominator data for infants under 1 year, stratified by age in months, were obtained from Statistics Canada. RESULTS Annual intussusception hospitalization rates ranged from 20-30 per 100,000 infants over the study period, with no evidence of a trend over time. Intussusception hospitalization rates were highest in infants 4 to <8 months and lowest in those under 2 months or between 10 and <12 months. Males had higher rates than females both overall and within each age group. The rate of intussusception hospitalization after rotavirus vaccine program introduction was 22.4 (95% CI: 18.3, 27.4) compared to 23.4 (95% CI: 21.5, 25.4) per 100,000 before program introduction. CONCLUSIONS We have described baseline intussusception hospitalization rates for infants in Canada and have found no evidence of a change in rate after implementation of routine rotavirus immunization programs.
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Affiliation(s)
- Steven Hawken
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Robin Ducharme
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Laura C. Rosella
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Eric I. Benchimol
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Division of Gastroenterology, Ottawa, Ontario, Canada
| | - Joanne M. Langley
- Departments of Pediatrics & Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Centre for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Kumanan Wilson
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Natasha S. Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Scott A. Halperin
- Canadian Centre for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shalina Desai
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Monika Naus
- British Columbia Centre for Disease Control, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Salah M. Mahmud
- Vaccine and Drug Evaluation Centre, Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Shelley L. Deeks
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Wilson SE, Quach S, MacDonald SE, Naus M, Deeks SL, Crowcroft NS, Mahmud SM, Tran D, Kwong JC, Tu K, Johnson C, Desai S. Immunization information systems in Canada: Attributes, functionality, strengths and challenges. A Canadian Immunization Research Network study. Can J Public Health 2017; 107:e575-e582. [PMID: 28252378 DOI: 10.17269/cjph.107.5679] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/11/2016] [Accepted: 09/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Canada does not have a national immunization registry. Diverse systems to record vaccine uptake exist, but these have not been systematically described. Our objective was to describe the immunization information systems (IISs) and non-IIS processes used to record childhood and adolescent vaccinations, and to outline the strengths and limitations of the systems and processes. METHODS We collected information from key informants regarding their provincial, territorial or federal organization's surveillance systems for assessing immunization coverage. Information collection consisted of a self-administered questionnaire and a follow-up interview. We evaluated systems against attributes derived from the literature using content analysis. RESULTS Twenty-six individuals across 16 public health organizations participated over the period of April to August 2015. Twelve of Canada's 13 provinces and territories (P/Ts) and two organizations involved in health service delivery for on-reserve First Nations people participated. Across systems, there were differences in data collection processes, reporting capabilities and advanced functionality. Commonly cited challenges included timeliness and data completeness of records, particularly for physician-administered immunizations. Privacy considerations and the need for data standards were stated as challenges to the goal of information sharing across P/T systems. Many P/Ts have recently implemented new systems and, in some cases, legislation to improve timeliness and/or completeness. CONCLUSION Considerable variability exists among IISs and non-IIS processes used to assess immunization coverage in Canada. Although some P/Ts have already pursued legislative or policy initiatives to address the completeness and timeliness of information, many additional opportunities exist in the information technology realm.
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Affiliation(s)
- Sarah E Wilson
- Public Health Ontario, Toronto, ON; Dalla Lana School of Public Health, University of Toronto, Toronto, ON; Institute for Clinical Evaluative Services, Toronto, ON.
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Top KA, Boucher FD, McConnell A, Pernica J, Pham-Huy A, Vaudry W, Deeks SL, Noya F, Tapiero B, Quach C, Tran D, Morris SK, Dobson S, Sadarangani M, McNeil SA, MacKinnon-Cameron D, Ye L, Halperin SA, De Serres G. Immunizing Patients with Adverse Events Following Immunization in the Canadian Special Immunization Clinic Network (2015–2017). Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1339] [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] [Indexed: 11/13/2022] Open
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Strifler L, Morris SK, Dang V, Tu HAT, Minhas RS, Jamieson FB, Deeks SL, Crowcroft NS, Sander B. The Health Burden of Invasive Meningococcal Disease: A Systematic Review. J Pediatric Infect Dis Soc 2016; 5:417-430. [PMID: 26501470 DOI: 10.1093/jpids/piv065] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 09/01/2015] [Indexed: 11/13/2022]
Abstract
OF KEY POINTS Although relatively rare, invasive meningococcal disease continues to be a health concern, especially in young children. This systematic review clearly delineates both the near- and long-term morbidities that can occur after, and persist beyond, the period of acute illness. BACKGROUND Although rare, invasive meningococcal disease (IMD) continues to be a health concern in high-income countries because of its severe morbidity and relatively high case fatality rate, especially in young children. However, studies measuring sequelae of IMD across the spectrum of invasive syndromes have not been systematically reviewed. We conducted a systematic review of sequelae attributable to IMD and quality of life (QoL) in IMD survivors in high-income countries. METHODS We searched Medline, Embase, and HealthSTAR for primary studies that assessed sequelae or QoL in individuals of any age with and without IMD. Two independent reviewers screened articles, abstracted data, and performed quality appraisal. The findings were summarized qualitatively. RESULTS Of 1884 citations screened, 17 studies were included. The most commonly assessed sequelae were hearing impairment, cognitive impairment, and psychological problems. In general, children with IMD had a greater incidence of hearing loss and psychological disorders, including attention-deficit/hyperactivity disorder. However, its effects on intelligence in children remain unclear. No statistical differences in overall cognitive function in adults were reported. The odds of death were significantly increased with IMD at hospital discharge and up to 30 years after disease. Lower overall QoL was observed in those who had IMD versus controls. CONCLUSIONS The results of this systematic review delineate both the short- and long-term morbidities that can occur after, and persist beyond, the period of acute illness. A better understanding of the full spectrum of IMD sequelae is critical for assessing the burden of IMD and supporting healthcare planning and decision making in light of new vaccines.
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Affiliation(s)
- Lisa Strifler
- Knowledge Translation Program, St. Michael's Hospital.,Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children.,Department of Paediatrics, University of Toronto
| | | | - Hong Anh T Tu
- Institute of Health Policy, Management and Evaluation, University of Toronto
| | | | - Frances B Jamieson
- Public Health Ontario.,Department of Laboratory Medicine and Pathobiology
| | - Shelley L Deeks
- Public Health Ontario.,Dalla Lana School of Public Health, University of Toronto
| | - Natasha S Crowcroft
- Public Health Ontario.,Dalla Lana School of Public Health, University of Toronto
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto.,Public Health Ontario.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Schwartz KL, Kwong JC, Deeks SL, Campitelli MA, Jamieson FB, Marchand-Austin A, Stukel TA, Rosella L, Daneman N, Bolotin S, Drews SJ, Rilkoff H, Crowcroft NS. Effectiveness of pertussis vaccination and duration of immunity. CMAJ 2016; 188:E399-E406. [PMID: 27672225 DOI: 10.1503/cmaj.160193] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A resurgence of pertussis cases among both vaccinated and unvaccinated people raises questions about vaccine effectiveness over time. Our objective was to study the effectiveness of the pertussis vaccine and characterize the effect of waning immunity and whole-cell vaccine priming. METHODS We used the test-negative design, a nested case-control study with test-negative individuals as controls. We constructed multivariable logistic regression models to estimate odds ratios (ORs). Vaccine effectiveness was calculated as (1 - OR) × 100. We assessed waning immunity by calculating the odds of developing pertussis per year since last vaccination and evaluated the relative effectiveness of priming with acellular versus whole-cell vaccine. RESULTS Between Dec. 7, 2009, and Mar. 31, 2013, data on 5867 individuals (486 test-positive cases and 5381 test-negative controls) were available for analysis. Adjusted vaccine effectiveness was 80% (95% confidence interval [CI] 71% to 86%) at 15-364 days, 84% (95% CI 77% to 89%) at 1-3 years, 62% (95% CI 42% to 75%) at 4-7 years and 41% (95% CI 0% to 66%) at 8 or more years since last vaccination. We observed waning immunity with the acellular vaccine, with an adjusted OR for pertussis infection of 1.27 (95% CI 1.20 to 1.34) per year since last vaccination. Acellular, versus whole-cell, vaccine priming was associated with an increased odds of pertussis (adjusted OR 2.15, 95% CI 1.30 to 3.57). INTERPRETATION We observed high early effectiveness of the pertussis vaccine that rapidly declined as time since last vaccination surpassed 4 years, particularly with acellular vaccine priming. Considering whole-cell vaccine priming and/or boosters in pregnancy to optimize pertussis control may be prudent.
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Affiliation(s)
- Kevin L Schwartz
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta.
| | - Jeffrey C Kwong
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta
| | - Shelley L Deeks
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta
| | - Michael A Campitelli
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta
| | - Frances B Jamieson
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta
| | - Alex Marchand-Austin
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta
| | - Therese A Stukel
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta
| | - Laura Rosella
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta
| | - Nick Daneman
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta
| | - Shelly Bolotin
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta
| | - Steven J Drews
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta
| | - Heather Rilkoff
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta
| | - Natasha S Crowcroft
- Institute for Clinical Evaluative Sciences (Schwartz, Kwong, Campitelli, Stukel, Daneman); Institute of Health Policy, Management, and Evaluation (Schwartz, Stukel, Rosella, Daneman), University of Toronto; The Hospital for Sick Children (Schwartz); Public Health Ontario (Kwong, Deeks, Rosella, Rilkoff, Crowcroft); Dalla Lana School of Public Health (Kwong, Deeks, Bolotin, Crowcroft), University of Toronto; Department of Family and Community Medicine (Kwong), University of Toronto; University Health Network (Kwong); Department of Laboratory Medicine and Pathobiology (Jamieson, Marchand-Austin, Crowcroft), University of Toronto; Public Health Ontario Laboratory Services (Jamieson, Marchand-Austin); Toronto, Ont.; ProvLab Alberta, University of Alberta Hospital (Drews); Department of Pathology and Laboratory Medicine (Drews), University of Alberta, Edmonton, Alta
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Guerra FM, Rosella LC, Dunn S, Wilson SE, Chen C, Deeks SL. Early impact of Ontario's human papillomavirus (HPV) vaccination program on anogenital warts (AGWs): A population-based assessment. Vaccine 2016; 34:4678-4683. [PMID: 27527815 DOI: 10.1016/j.vaccine.2016.08.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This study aimed to evaluate the early population impact of Ontario's school-based human papillomavirus (HPV) vaccination program, implemented in September 2007 for grade 8 females, by comparing anogenital wart (AGW) health care utilization before and after vaccine program implementation, in program-eligible and program-ineligible cohorts, focusing on 15-26year olds. METHODS Using a retrospective longitudinal population-based study design, health administrative data were used to identify incident AGWs and total health service utilization (HSU) for AGWs for Ontario residents 15years and older between April 1 2004 and March 31 2014. The study period was divided into two eras: the pre-vaccine program era and the vaccine program era. Negative binomial models were generated to analyze trends across time by age group and sex. We adjusted female rates for routine Papanicolaou (Pap) testing to address spillover effects of Pap smear policy changes on AGW diagnosis. RESULTS Between fiscal years 2004 and 2013, AGW incidence decreased 2.6% on average per year in 15-17year old females, and total HSU for AGWs decreased an average of 4.8% and 2.2% per year in 15-17 and 18-20year old females. Comparing the vaccine era to the pre-vaccine era, AGW incidence decreased 6.5% in 18-20year old females, and AGW HSU decreased 13.8%, 11.1%, and 10.0% in 15-17, 18-20, and 21-23year old females respectively. In contrast, male AGW incidence rates increased an average of 4.1%, 2.8%, and 0.9% per year in 15-17, 21-23, and 24-26year old males respectively. AGW incidence rates increased 12.2% in 15-17year old males from the pre-vaccine to vaccine era. CONCLUSION The decline in AGW incidence and HSU in program-eligible females suggests the school-based HPV vaccination program has had an early population impact in Ontario. The increasing AGW incidence in males suggests no early evidence of herd effects in males.
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Affiliation(s)
- Fiona M Guerra
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada.
| | - Laura C Rosella
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada; Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Avenue G106, Toronto, ON M4N 3M5, Canada.
| | - Sheila Dunn
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada; Women's College Hospital and Women's College Research Institute, 790 Bay St, Toronto, ON M5G 1N8, Canada.
| | - Sarah E Wilson
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada; Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Avenue G106, Toronto, ON M4N 3M5, Canada.
| | - Cynthia Chen
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada.
| | - Shelley L Deeks
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
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Atkinson KM, Westeinde J, Ducharme R, Wilson SE, Deeks SL, Crowcroft N, Hawken S, Wilson K. Can mobile technologies improve on-time vaccination? A study piloting maternal use of ImmunizeCA, a Pan-Canadian immunization app. Hum Vaccin Immunother 2016; 12:2654-2661. [PMID: 27322109 DOI: 10.1080/21645515.2016.1194146] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Mobile applications have the potential to influence vaccination behavior, including on-time vaccination. We sought to determine whether the use of a mobile immunization app was associated with the likelihood of reporting on-time vaccination in a cohort of 50 childbearing women. In this pilot study, we describe participant reported app use, knowledge, attitudes or beliefs regarding pediatric vaccination and technology readiness index (TRI) scores. To explore if app use is associated with change in attitudes, beliefs or behavior, participants were instructed complete a baseline survey at recruitment then download the app. A follow up survey followed 6-months later, reexamining concepts from the first survey as well as collecting participant TRI scores. Changes in Likert scores between pre and post survey questions were compared and multivariate logistic regression was used to assess the relationship between TRI score and select survey responses. Thirty-two percent of participants perceived that the app made them more likely to vaccinate on time. We found some individuals' attitudes toward vaccines improved, some became less supportive and in others there was no change. The mean participant TRI score was 3.25(IQR 0.78) out of a maximum score of 5, indicating a moderate level of technological adoption among the study cohort population. While the app was well received, these preliminary results showed participant attitudes toward vaccination moved dichotomously. Barriers to adoption remain in both usability and accessibility of mobile solutions, which are in part dependent on the user's innate characteristics such as technology readiness.
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Affiliation(s)
- Katherine M Atkinson
- a Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa , Canada.,b Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - Jacqueline Westeinde
- a Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa , Canada
| | - Robin Ducharme
- a Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa , Canada
| | - Sarah E Wilson
- c Public Health Ontario , Toronto , Canada.,d Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
| | - Shelley L Deeks
- c Public Health Ontario , Toronto , Canada.,d Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
| | - Natasha Crowcroft
- c Public Health Ontario , Toronto , Canada.,d Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
| | - Steven Hawken
- a Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa , Canada.,f Departments of Epidemiology and Community Medicine , University of Ottawa , Ottawa , Canada
| | - Kumanan Wilson
- a Clinical Epidemiology Program, Ottawa Hospital Research Institute , Ottawa , Canada.,e Department of Medicine , University of Ottawa , Ottawa , Canada.,f Departments of Epidemiology and Community Medicine , University of Ottawa , Ottawa , Canada
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Wilson SE, Rosella LC, Wang J, Le Saux N, Crowcroft NS, Harris T, Bolotin S, Deeks SL. Population-Level Impact of Ontario's Infant Rotavirus Immunization Program: Evidence of Direct and Indirect Effects. PLoS One 2016; 11:e0154340. [PMID: 27168335 PMCID: PMC4864308 DOI: 10.1371/journal.pone.0154340] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/11/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the direct and indirect population impact of rotavirus (RV) immunization on hospitalizations and emergency department (ED) visits for acute gastroenteritis (AGE) in Ontario before and after the publicly-funded RV immunization program. METHODS Administrative data was used to identify ED visits and hospitalizations for all Ontarians using ICD-10 codes. We used two outcome definitions: RV-specific AGE (RV-AGE) and codes representing RV-, other viral and cause unspecified AGE ("overall AGE"). The pre-program and public program periods were August 1, 2005 to July 31, 2011; and August 1, 2011 to March 31, 2013, respectively. A negative binominal regression model that included the effect of time was used to calculate rates and rate ratios (RRs) and 95% confidence intervals (CIs) for RV-AGE and overall AGE between periods, after adjusting for age, seasonality and secular trends. Analyses were conducted for all ages combined and age stratified. RESULTS Relative to the pre-program period, the adjusted RRs for RV-AGE and overall AGE hospitalizations in the public program period were 0.29 (95%CI: 0.22-0.39) and 0.68 (95%CI: 0.62-0.75), respectively. Significant reductions in RV-AGE hospitalizations were noted overall and for the following age bands: < 12 months, 12-23 months, 24-35 months, 3-4 years, and 5-19 years. Significant declines in overall AGE hospitalizations were observed across all age bands, including older adults > = 65 years (RR 0.80, 95%CI: 0.72-0.90). The program was associated with adjusted RRs of 0.32 (95% CI: 0.20-0.52) for RV-AGE ED visits and 0.90 (95% CI: 0.85-0.96) for overall AGE ED visits. CONCLUSIONS This large, population-based study provides evidence of the impact of RV vaccine in preventing hospitalizations and ED visits for RV-AGE and overall AGE, including herd effects.
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Affiliation(s)
- Sarah E. Wilson
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Laura C. Rosella
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jun Wang
- Public Health Ontario, Toronto, Ontario, Canada
| | - Nicole Le Saux
- Division of Infectious Disease, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Natasha S. Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Tara Harris
- Public Health Ontario, Toronto, Ontario, Canada
| | - Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Schwartz KL, Tu K, Wing L, Campitelli MA, Crowcroft NS, Deeks SL, Wilson SE, Wilson K, Gemmill I, Kwong JC. Validation of infant immunization billing codes in administrative data. Hum Vaccin Immunother 2016; 11:1840-7. [PMID: 26075651 PMCID: PMC4514409 DOI: 10.1080/21645515.2015.1043499] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Ontario has a single payer provincial health insurance program. Administrative data may provide a potentially robust source of information for post-marketing vaccine studies. Vaccine-specific immunization billing codes were introduced in 2011. Our objective was to validate Ontario's universal health care administrative datasets to assess infant immunization status. Electronic medical record data from the Electronic Medical Record Administrative data Linked Database (EMRALD) was used as the reference standard to calculate performance characteristics of the Ontario Health Insurance Plan (OHIP) database vaccine-specific and general immunization codes for 4 primary infant immunizations: diphtheria, tetanus, acellular pertussis, inactivated polio, Haemophilus influenzae type B (DTaP-IPV-Hib) combination vaccine, pneumococcal conjugate vaccine, measles, mumps, rubella (MMR) vaccine, and meningococcal conjugate serogroup C vaccine. OHIP billing claims had specificity ranging from 81% to 92%, sensitivity 70% to 83%, positive predictive value (PPV) 97% to 99%, and negative predictive value (NPV) 13% to 46% for identifying the various specific vaccines in administrative data. For cohorts vaccinated in the new code introduction phase, using both the vaccine-specific and general codes had higher sensitivity than the vaccine-specific codes alone. In conclusion, immunization billing claims from administrative data in Ontario had high specificity and PPV, moderate sensitivity, and low NPV. This study identifies some of the applications of utilizing administrative data for post-marketing vaccine studies. However, limitations of these data decrease their utility for measuring vaccine coverage and effectiveness. Therefore, the establishment of a comprehensive and linkable immunization registry should be a provincial priority.
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Key Words
- CIC, Citizen and Immigration Canada
- CIHI-DAD, Canadian Institute of Health Information Discharge Abstract Database
- COC, continuity of care
- DTaP-IPV-Hib, diphtheria, tetanus, acellular pertussis, inactivated polio, Haemophilus influenzae type B vaccine
- EMR, electronic medical records
- EMRALD, Electronic Medical Record Administrative data Linked Database
- ICES, Institute for Clinical Evaluative Sciences
- MMR, measles, mumps, rubella vaccine
- MenC, meningococcal conjugate serogroup C vaccine
- NPV, negative predictive value
- OHIP, Ontario Health Insurance Plan
- PC, pneumococcal conjugate vaccine
- PPV, positive predictive value
- RPDB, Registered Persons Database
- diphtheria-tetanus-pertussis vaccine
- health services
- measles-mumps-rubella vaccine
- meningococcal vaccines
- pneumococcal vaccines
- vaccine combined
- validation studies
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Affiliation(s)
- Kevin L Schwartz
- a Institute for Clinical Evaluative Sciences ; Toronto , Ontario , Canada
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49
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Guerra FM, Rosella LC, Dunn S, Wilson SE, Chen C, Deeks SL. Health service utilisation for anogenital warts in Ontario, Canada prior to the human papillomavirus (HPV) vaccine programme introduction: a retrospective longitudinal population-based study. BMJ Open 2016; 6:e009914. [PMID: 26966057 PMCID: PMC4800155 DOI: 10.1136/bmjopen-2015-009914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Trends in occurrence of anogenital warts (AGWs) can provide early evidence of human papillomavirus (HPV) vaccination programme impact on preventing HPV infection and HPV-induced lesions. The objective of this study was to provide a baseline of AGW epidemiology in Ontario prior to the introduction of the publicly-funded school-based HPV vaccination programme in September 2007. SETTING AND PARTICIPANTS As a retrospective longitudinal population-based study, we used health administrative data as a proxy to estimate incident AGWs and total health service utilisation (HSU) for AGWs for all Ontario residents 15 years and older with valid health cards between 1 April 2003 and 31 March 2007. OUTCOME MEASURES The outcome of interest was AGW healthcare utilisation identified using the International Classification of Diseases, 10th revision (ICD-10) diagnostic code for AGWs, as well as an algorithm for identifying AGW physician office visits in a database with a unique system of diagnostic and procedural codes. An AGW case was considered incident if preceded by 12 months without HSU for AGWs. Time trends by age group and sex were analysed. RESULTS Between fiscal years 2003 and 2006, we identified 123,247 health service visits for AGWs by 51,436 Ontario residents 15 years and older. Incident AGWs peaked in females and males in the 21-23 year age group, at 3.74 per 1000 and 2.81 per 1000, respectively. HSU for AGWs peaked in females and males within the 21-23 year age group, at 9.34 per 1000 and 7.22 per 1000, respectively. CONCLUSIONS To the best of our knowledge, this is the first population-based study of AGW incidence and HSU in Ontario. The sex and age distribution of individuals with incident and prevalent AGWs in Ontario was similar to that of other provinces before HPV vaccine programme implementation in Canada.
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Affiliation(s)
| | - Laura C Rosella
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sheila Dunn
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada
| | - Sarah E Wilson
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Shelley L Deeks
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Drolet M, Deeks SL, Kliewer E, Musto G, Lambert P, Brisson M. Can high overall human papillomavirus vaccination coverage hide sociodemographic inequalities? An ecological analysis in Canada. Vaccine 2016; 34:1874-80. [PMID: 26954465 DOI: 10.1016/j.vaccine.2016.02.069] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/22/2016] [Accepted: 02/25/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination programs have been implemented in more than 50 countries. These programs offer tremendous promise of reducing HPV-related disease burden. However, failure to achieve high coverage among high-risk groups may mitigate program success and increase inequalities. We examined sociodemographic inequalities in HPV vaccination coverage in 4 Canadian provinces (Quebec (QC), Ontario (ON), Manitoba (MB), British Columbia (BC)). METHODS We obtained annual HPV vaccination coverage of pre-adolescent girls at provincial and regional levels, from the start of programs to 2012/2013. Regions refer to administrative areas responsible for vaccine implementation and monitoring (there are 18/36/10/16 regions in QC/ON/MB/BC). We obtained regions' sociodemographic characteristics from Statistics Canada Census. We used univariate weighted linear regression to examine the associations between regions' sociodemographic characteristics and HPV vaccination coverage. RESULTS Provincial HPV vaccination coverage is generally high (QC:78%; ON:80%; MB:64%, BC:69%, 2012/13). QC had the highest provincial vaccination coverage since the program start, but had the greatest inequalities. In QC, regional HPV vaccination coverage was lower in regions with higher proportions of socially deprived individuals, immigrants, and/or native English speakers (p<0.0001). These inequalities remained stable over time. Regional-level analysis did not reveal inequalities in ON, MB and BC. CONCLUSION School-based HPV vaccination programs have resulted in high vaccination coverage in four Canadian provinces. Nonetheless, high overall coverage did not necessarily translate into equality in coverage. Future work is needed to understand underlying causes of inequalities and how this could impact existing inequalities in HPV-related diseases and overall program success.
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Affiliation(s)
- Melanie Drolet
- Centre de recherche du CHU de Québec, Axe SP-POS, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Shelley L Deeks
- Public Health Ontario, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Erich Kliewer
- CancerCare Manitoba, Manitoba, Canada; University of Manitoba, Manitoba, Canada; British Columbia Cancer Agency, British Columbia, Canada
| | | | | | - Marc Brisson
- Centre de recherche du CHU de Québec, Axe SP-POS, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, UK.
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