IntroductionCOVID-19 vaccines require enhanced safety monitoring after emergency approval. The Ca... more IntroductionCOVID-19 vaccines require enhanced safety monitoring after emergency approval. The Canadian National Vaccine Safety Network monitors the safety of COVID-19 vaccines and provides enhanced monitoring for healthy, auto-immune, immunocompromised, pregnant and breastfeeding populations and allows for the detection of safety signals.Methods and analysisOnline participant reporting of health events in vaccinated and unvaccinated individuals 12 years of age and older is captured in three surveys: 1 week after dose 1, 1 week after dose 2 and 7 months after dose 1. Medically attended events are followed up by telephone. The number, percentage, rate per 10 000 and incident rate ratios with 95% CIs are calculated by health event, vaccine type, sex and in 10-year age groups.Ethics and disseminationEach study site has Research Ethics Board approvals for the project (UBC Children’s & Women’s, CIUSSS de l'Estrie—CHUS, Health PEI, Conjoint Health Research Ethics Board, University of ...
BackgroundPregnant individuals have been receiving COVID-19 vaccines following pre-authorization ... more BackgroundPregnant individuals have been receiving COVID-19 vaccines following pre-authorization clinical trials in non-pregnant people. This study aimed to determine significant health events amongst pregnant females after COVID-19 vaccination, compared with unvaccinated pregnant controls and vaccinated non-pregnant individuals.MethodsStudy participants were pregnant and non-pregnant females aged 15-49 years who had received any COVID-19 vaccine, and pregnant unvaccinated controls. Participants reported significant health events occurring within seven days of vaccination. We employed multivariable logistic regression to examine significant health events associated with mRNA vaccines.FindingsOverall 226/5,597(4.0%) vaccinated pregnant females reported a significant health event after dose one of an mRNA vaccine, and 227/3,108(7.3%) after dose two, compared with 11/339(3.2%) pregnant unvaccinated females. Pregnant vaccinated females had an increased odds of a significant health event...
Background Community-acquired pneumonia (CAP) causes substantial morbidity and mortality. There i... more Background Community-acquired pneumonia (CAP) causes substantial morbidity and mortality. There is a lack of data on the comprehensive burden of CAP across the life span in Canada. We estimated the incidence of all-cause CAP in all age groups in Ontario and British Columbia (BC), Canada. Methods We identified hospitalized and outpatient CAP episodes from the Discharge Abstract Database (DAD) and physician billing claims databases (Ontario Health Insurance Plan in Ontario and Medical Services Plan in BC) in both provinces. The National Ambulatory Care Reporting System was used to identify CAP episodes from emergency department visits in Ontario. CAP recorded with a primary or secondary diagnosis was identified using International Classification of Diseases 9 (480–486, 510, 513) and 10 (J10.0, J11.0, J12–J18, J86.9, J85.1) codes. We estimated the age and sex adjusted annual incidence of CAP overall, and by age groups (0–4, 5–17, 18–39, 40–64, 65–74, 75–84 and ≥85 years) according to r...
BACKGROUND Invasive pneumococcal disease (IPD) burden, evaluated in Canada using reported confirm... more BACKGROUND Invasive pneumococcal disease (IPD) burden, evaluated in Canada using reported confirmed cases in surveillance systems, is likely underestimated due to underreporting. We estimated the burden of IPD in Ontario and British Columbia (BC) by combining surveillance data with health administrative databases. METHODS We established a cohort of 27,525 individuals in Ontario and BC. Laboratory-confirmed IPD cases were identified from Ontario's integrated Public Health Information System and the BC Centre for Disease Control Public Health Laboratory. Possible IPD cases were identified from hospitalization data in both provinces, and from emergency department visit data in Ontario. We estimated the age and sex adjusted annual incidence of IPD and pneumococcal conjugate/polysaccharide vaccine (PCV/PPV) serotype-specific IPD using Poisson regression models. RESULTS In Ontario, 20,205 overall IPD cases, including 15,299 laboratory-confirmed cases, were identified with relatively stable age- and sex-adjusted annual incidence rates ranging from 13.7/100,000 (2005) to 13.6/100,000 (2018). In BC, 7,320 overall IPD cases, including 5,932 laboratory-confirmed cases were identified; annual incidence rates increased from 10.9/100,000 (2002) to 13.2/100,000 (2018). Older adults aged ≥ 85 years had the highest incidence rates. During 2007-2018 the incidence of PCV7 serotypes and additional PCV13 serotypes decreased while the incidence of unique PPV23 and non-vaccine serotypes increased in both provinces. CONCLUSIONS IPD continues to cause a substantial public health burden in Canada despite publicly funded pneumococcal vaccination programs, resulting in part from an increase in unique PPV23 and non-vaccine serotypes.
Among the 5 patients with acute tubulointerstitial nephritis, 4 were biopsy-proven, and 1 was pre... more Among the 5 patients with acute tubulointerstitial nephritis, 4 were biopsy-proven, and 1 was presumed based on the clinical history of recent NSAID use. Renal biopsies were performed in six patients, and histopathological diagnoses were pigment cast nephropathy (n=1), acute tubulointerstitial nephritis (n=4), and infection-related GN (n=1). Among the four patients with acute tubulointerstitial nephritis, two had exposures to NSAIDs and native medications, while a clear aetiology could not be identified in the other two. One patient, in addition, had the incidental finding of extramedullary haematopoiesis in the kidney, which was secondary to HIV-related bone marrow fibrosis. The overall mortality rate was 41.4% (5 patients died during hospitalisation, 7 patients died during follow-up). Seven patients remained dialysis-dependent at the time of discharge/death. Conclusions: While we identified a very vast spectrum of AKI, overwhelmingly the most common cause in our hospital population remains sepsis. A significant proportion required renal replacement therapy, and the patients in our cohort suffered a high mortality rate. Limitations include observational study design, referral bias, and small sample size.
Aim Combination vaccines decrease the number of needles required, addressing a common concern of ... more Aim Combination vaccines decrease the number of needles required, addressing a common concern of parents. However, some parents are hesitant about combination vaccines and/or want to opt out of certain vaccine components. This study assessed whether introduction of the combination MMRV vaccine influenced coverage levels for measles- and varicella-containing vaccines. Study and methods This was a population-based study of children born in Alberta, Canada between 2006 and 2012. We utilized administrative health data to evaluate coverage for the first dose of measles- and varicella-containing vaccines at the age of 24 months (i.e. between 2008 and 2014) before and after introduction of the combination MMRV vaccine in 2010. Among those who were vaccinated, we assessed whether any children continued to receive separate vaccines after the combination vaccine was introduced. Results Of 308,212 children, 272,345 (88.36%) were vaccinated with measles- and/or varicella-containing vaccines at ...
Background: Concern about adverse events following immunization is frequently cited by both those... more Background: Concern about adverse events following immunization is frequently cited by both those who receive or decline vaccines. Neurological adverse events are especially concerning. Objectives: Our aim was to detect associations between seasonal influenza vaccination and the occurrence of severe anesthesia/paresthesia or severe headaches. Methods: Data were analyzed from the Canadian National Vaccine Safety network. Events occuring on days 0-7 were self-reported and prevented daily activity, led to school or work absenteeism, or required medical attention. Controls were the previous year's vaccinees; events in controls were collected prior to the start of the influenza vaccination program of each year (2012/13 through 2016/17). Multivariable logistic regression was used to determine the association between seasonal influenza vaccination and the occurrence of anesthesia/paresthesia or severe headaches. Results: The total sample was 107,565 for investigating anesthesia/paresthesia and 97,420 for investigating severe headaches. Anesthesia/paresthesia was reported by 104/107,565 (0.10%) participants; 63/69,129 (0.09%) vaccinees and 41/38,436 (0.11%) controls (adjusted odds ratio (aOR) = 0.89; 95% CI = 0.60, 1.32). Severe headaches were reported by 1361/97,420 (1.40%) participants; 907/61,463 (1.48%) vaccinees and 454/35,957 (1.26%) controls (aOR = 1.21; 95% CI = 1.08, 1.36). No specific vaccine product was associated with severe headaches. Conclusions: Our study found no association between severe anesthesia/paresthesia and seasonal influenza vaccination. While there was an association with severe headaches as an adverse event following influenza vaccination, the rates of these events are similar to rates reported from clinical trials and are not a cause for additional concern.
In Canada, Indigenous people have higher human papillomavirus (HPV) infection rates, lower screen... more In Canada, Indigenous people have higher human papillomavirus (HPV) infection rates, lower screening rates for cervical cancer, and higher rates of invasive cancer, leading to worse cervical cancer-related outcomes than observed in non-Indigenous Canadian women. Lingering harms from European colonization drive these health inequities and create public health challenges. Policy guidance is needed to optimize HPV vaccination rates and, thereby, decrease the burden of HPV-related illness, including high-morbidity surgical procedures and chemo-radiotherapy. The Enhancing HPV Vaccination In First Nations Populations in Alberta (EHVINA) project focuses on First Nations, a diverse subset of recognized Indigenous people in Canada, and seeks to increase HPV vaccination among girls and boys living in First Nation communities. Developing an effective strategy requires partnership with affected communities to better understand knowledge and perceptions about cancer, healthcare, and the HPV vacc...
HCW were enrolled and surveyed over two seasons and > 90% reported no severe event following vacc... more HCW were enrolled and surveyed over two seasons and > 90% reported no severe event following vaccination. Validated severe event rates were similar in vaccinated HCW and unvaccinated HCW (2.2% vs 2.3%; p < 0.70). The questionnaire was accurately completed for most reported symptoms, matched the validated report and was able to detect events of interest. Prior to the safety concern, the implicated vaccine was in use at one centre. Reassuring safety data were provided to public health authorities 48 hours after the vaccine was temporarily suspended. Data from this and similar networks can be used for rapid evaluation of vaccine safety and for safety assessment as required by the European Medicines Agency in 2015.
We previously reported trends in pneumococcal nasopharyngeal carriage in the post-PCV13 era as de... more We previously reported trends in pneumococcal nasopharyngeal carriage in the post-PCV13 era as detected by conventional culture methods. Our current aim is to assess if there are fundamental differences in the clinical and demographic features of children who have pneumococcal carriage detected by qPCR compared with culture analysis. The CASPER team conducted point-prevalence surveys in 2016 in healthy children in Calgary to determine trends in overall and serotype-specific pneumococcal nasopharyngeal carriage. Being 18 months of age (p = 0.009), having at least one sibling under 2 years of age (p = 0.04), having only sibling(s) over 2 years of age (p = 0.001), and childcare attendance (p = 0.005) were associated with carriage by qPCR methods only. Having only sibling(s) older than 2 years of age was associated with carriage detected by both qPCR and culture methods (p = 0.001). No clinical factors were associated with carriage detected by both qPCR and culture compared to qPCR meth...
OBJECTIVE: To provide evidence-based recommendations for classification, diagnosis and treatment ... more OBJECTIVE: To provide evidence-based recommendations for classification, diagnosis and treatment of acute, chronic and recurrent acute sinusitis in adults and children.DATA SOURCES: Review articles, textbooks, other published guidelines and recommendations of task force members.STUDY SELECTION: One hundred and seventy-one papers addressing one or all of the objectives.DATA EXTRACTION: Relevant data were collated under each objective.DATA SYNTHESIS: Validity of diagnostic and treatment evidence was assessed by using the methodological recommendations of Sackett et al and the canadian Task Force on Periodic Health Examination, respectively. Where there was a paucity of data, consensus of task force members was reached.CONCLUSIONS: Sinusitis is classified as acute, chronic or recurrent acute disease according to duration and frequency of symptoms and response to therapy (expert opinion). Potential risk factors, concomitant diseases and complications are identified (limited evidence). D...
Background: The epidemiology of pediatric bloodstream infection has not been well defined in gene... more Background: The epidemiology of pediatric bloodstream infection has not been well defined in general populations. The primary objective of this study was to describe the burden of illness of pediatric bloodstream infections in a large Canadian region and secondarily to assess the effect of implementation of universal infant immunization with 7-valent pneumococcal conjugate vaccine (PCV7) in 2002. Methods: Surveillance for all bloodstream infections was conducted among pediatric (Ͻ18 years) residents of the Calgary Health Region during 2000-2006. Results: Nine hundred ninety-five episodes of bloodstream infection occurred for an overall annual incidence of 53.7 per 100,000. Forty-eight percent were community-acquired, 27% were nosocomial-acquired, and 26% were healthcare-associated community onset. The risk for bloodstream infection was highest in neonates. The annual incidence of bloodstream infection changed significantly (P Ͻ 0.001) and was attributed to a decreasing incidence of community (P ϭ 0.001) acquired disease. The most common species isolated were Streptococcus pneumoniae, Staphylococcus aureus, and Escherichia coli. Overall rates of pneumococcal infection decreased significantly in the post-PCV7 era (2004-2006) as compared with pre-PCV7 era (2000-2001) (4.6 vs. 13.6 per 100,000; P Ͻ 0.0001). This was even more pronounced in the subset with community-acquired disease (3.0 vs. 11.3 per 100,000; P Ͻ 0.0001) especially in the age group between 1 and 23 months of age (7.3 vs. 58.9 per 100,000; P Ͻ 0.0001). The overall mortality rate was 2 per 100,000/yr. Conclusions: Bloodstream infections are an important cause of disease in children. Implementation of PCV7 has been associated with a significant reduction in the overall burden of disease.
Background The Canadian National Vaccine Safety (CANVAS) network monitors the safety of seasonal ... more Background The Canadian National Vaccine Safety (CANVAS) network monitors the safety of seasonal influenza vaccines in Canada. Aim To provide enhanced surveillance for seasonal influenza and pandemic influenza vaccines. Methods In 2017/18 and 2018/19 influenza seasons, adults (≥ 15 years of age) and parents of children vaccinated with the seasonal influenza vaccine participated in an observational study using web-based active surveillance. Participants completed an online survey for health events occurring in the first 7 days after vaccination. Participants who received the influenza vaccine in the previous season, but had not yet been vaccinated for the current season, were unvaccinated controls. Results In 2017/18, 43,751 participants and in 2018/19, 47,798 completed the online safety survey. In total, 957 of 30,173 participants vaccinated in 2017/18 (3.2%; 95% confidence interval (CI): 3.0–3.4) and 857 of 25,799 participants vaccinated in 2018/19 (3.3%; 95% CI: 3.1–3.5) reported ...
Pediatrician and pediatric subspecialist density varies substantially among the various Canadian ... more Pediatrician and pediatric subspecialist density varies substantially among the various Canadian provinces, as well as among various states in the US. It is unknown whether this variability impacts health outcomes. To study this knowledge gap, we evaluated pediatric asthma admission rates within the 2 Canadian provinces of Manitoba and Saskatchewan, which have similarly sized pediatric populations and substantially different physician densities. This was a retrospective cross-sectional cohort study. Health regions defined by the provincial governments, have, in turn, been classified into "peer groups" by Statistics Canada, on the basis of common socio-economic characteristics and socio-demographic determinants of health. To study the relationship between the distribution of the pediatric workforce and health outcomes in Canadian children, asthma admission rates within comparable peer group regions in both provinces were examined by combining multiple national and provincia...
BACKGROUND: Antibiotics are commonly used in pediatrics in both community and hospital settings. ... more BACKGROUND: Antibiotics are commonly used in pediatrics in both community and hospital settings. To date, no study has examined antibiotic choices in Canada or in the USA by Pediatric Residents (PR) and recently graduated Pediatricians (RGP). OBJECTIVE: To describe the antibiotic choices made by PR and RGP for common infectious disease problems in children. PARTICIPATION AND METHODS: PR who are currently involved in 13 Canadian Pediatric PostGraduate Programs and RGP practicing in Canada for less than 5 years were mailed a questionnaire describing 10 common pediatric infectious disease clinical scenarios. RESULTS: 251/552 (45.5%) participants completed the survey of which 129/273 were PR (47.3%) and 122/279 (43.7%) were RGP. The following results were found in clinical cases where practice guidelines exist: Suggested antibiotics by respondents PR RGP Total
Background: Since the introduction of childhood pneumococcal conjugate vaccines, invasive pneumoc... more Background: Since the introduction of childhood pneumococcal conjugate vaccines, invasive pneumococcal disease (IPD) incidence has decreased in children and the predominant serotypes causing disease have changed. This study describes changes in the clinical features of IPD in children (<18 years) before and after the conjugate vaccine introduction. Methods: The Calgary Area Streptococcus pneumoniae Epidemiology Research study collects information on all IPD cases in Calgary, Alberta, Canada. Descriptive and regression analyses were used to compare IPD in the pre-vaccine (January 2000 to August 2002), post-7-valent protein-polysaccharide conjugate vaccine (September 2002 to June 2010) and post-13-valent protein-polysaccharide conjugate vaccine (PCV13) (July 2010 to December 2015) periods; intensive care unit and inpatient admissions were outcome measures. Results: The incidence of IPD in children (<18 years) decreased from an average of 17 cases/100,000/yr in 2000–2001 to 4 cases/100,000/yr in 2015. The median age of children presenting with IPD shifted from 2.0 years (interquartile range: 2.5) in the pre-vaccine period to 3.9 years (interquartile range: 6.2) in the post-PCV13 period. The proportion of children with a comorbidity that is an indication for pneumococcal vaccination did not change. Invasive disease with focus (meningitis, pneumonia, empyema, peritonitis) compared with invasive disease with bacteremia only increased from 44.6% in pre-vaccine to 64.0% and 61.4% in the post-7-valent protein-polysaccharide conjugate vaccine and post-PCV13 periods, respectively (P = 0.017). Having IPD in the post-PCV13 period compared with the pre-vaccine period was associated with an increased odds of hospitalization [Odds ratio (OR): 2.9; 95% Confidence Interval (CI): 1.4–6.2]. Conclusions: Clinical features of IPD have changed since pneumococcal conjugate vaccines were introduced, with a shift toward more focal infections requiring hospitalization. Although overall IPD cases have declined, disease that does occur appears to be more severe.
Canadian journal of public health = Revue canadienne de sante publique, Jan 16, 2017
Assessing timeliness and completeness of vaccine administration is important for evaluating the e... more Assessing timeliness and completeness of vaccine administration is important for evaluating the effectiveness of immunization programs. Few studies have reported timeliness, particularly in Canada. The objective of this study was to examine timeliness of the receipt of vaccination for each routine childhood recommended vaccine by 24 months of age among children in a community-based pregnancy cohort in Calgary, Alberta. Survey data from a community-based pregnancy cohort in Alberta were linked to Public Health vaccination records of children (n = 2763). The proportion of children receiving early, timely, delayed, or no vaccination was calculated. A dose was considered early if it was administered before the recommended age in days as per the vaccination schedule, timely if administered at any time from start of recommended age in days to age in days when delay counts were initiated, and delayed if it was administered on or after age in days when delay counts were initiated. Series co...
The diversity of Canadian infant meningococcal C conjugate (MenC) vaccine programs is unique amon... more The diversity of Canadian infant meningococcal C conjugate (MenC) vaccine programs is unique among countries providing MenC vaccines and offers a valuable opportunity to determine the optimal vaccine program. This longitudinal study assessed differences in sero-protection by three different vaccine schedules in children 2 years after receiving either one toddler MenC vaccine dose (one dose), one infant and one toddler dose (two dose), or two infant and one toddler MenC vaccine dose (three dose). Three similar cohorts of healthy infants from one, two and three dose program areas were enrolled before to their 12 month toddler dose and vaccinated with MenC-tetanus toxoid (MenC-TT) conjugate vaccine. Sera obtained 2 years later were assayed for serogroup C bactericidal activity using standardized procedures with rabbit as the exogenous complement source. Serum bactericidal activity titers &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 1:8 were considered protective. Results were available for 384 children. Rates of sero-protection at 36 months of age were significantly different between the one and three dose programs, but confidence intervals overlapped between the one and two dose programs and between the two and three dose programs: one dose 92% (95% CI 86% - 96%) vs. 99% (95%-100%) with two doses and 100% (97% - 100%) with three doses. Geometric mean titers were significantly different at 12.1 (10.8-13.5), 32.4 (28.9-36.2) and 50.6 (45.7-55.9) in the one, two and three dose programs respectively. At 36 months of age, evidence of sero-protection remained for greater than 90% of participants. Our results indicate that one toddler dose or one infant plus one toddler dose with MenC-TT vaccine provides sero-protection against MenC disease in early childhood.
During the Sars-CoV-2 pandemic in 2020, many countries shut down schools and businesses in an eff... more During the Sars-CoV-2 pandemic in 2020, many countries shut down schools and businesses in an effort to slow transmission of the virus. As some businesses reopened, increased public health protocols, mask wearing, hand sanitizer, and personal protective equipment use remained. The shut down and public health restrictions for person-to-person interaction, resulted in a decline of other transmissible diseases as well as Sars-CoV-2. In Calgary, the incidence of invasive disease due to Streptococcus pneumoniae declined to much lower levels than would be expected in early spring and remained low until December 2020. This decline occurred despite no changes in vaccine use and uptake.
IntroductionCOVID-19 vaccines require enhanced safety monitoring after emergency approval. The Ca... more IntroductionCOVID-19 vaccines require enhanced safety monitoring after emergency approval. The Canadian National Vaccine Safety Network monitors the safety of COVID-19 vaccines and provides enhanced monitoring for healthy, auto-immune, immunocompromised, pregnant and breastfeeding populations and allows for the detection of safety signals.Methods and analysisOnline participant reporting of health events in vaccinated and unvaccinated individuals 12 years of age and older is captured in three surveys: 1 week after dose 1, 1 week after dose 2 and 7 months after dose 1. Medically attended events are followed up by telephone. The number, percentage, rate per 10 000 and incident rate ratios with 95% CIs are calculated by health event, vaccine type, sex and in 10-year age groups.Ethics and disseminationEach study site has Research Ethics Board approvals for the project (UBC Children’s & Women’s, CIUSSS de l'Estrie—CHUS, Health PEI, Conjoint Health Research Ethics Board, University of ...
BackgroundPregnant individuals have been receiving COVID-19 vaccines following pre-authorization ... more BackgroundPregnant individuals have been receiving COVID-19 vaccines following pre-authorization clinical trials in non-pregnant people. This study aimed to determine significant health events amongst pregnant females after COVID-19 vaccination, compared with unvaccinated pregnant controls and vaccinated non-pregnant individuals.MethodsStudy participants were pregnant and non-pregnant females aged 15-49 years who had received any COVID-19 vaccine, and pregnant unvaccinated controls. Participants reported significant health events occurring within seven days of vaccination. We employed multivariable logistic regression to examine significant health events associated with mRNA vaccines.FindingsOverall 226/5,597(4.0%) vaccinated pregnant females reported a significant health event after dose one of an mRNA vaccine, and 227/3,108(7.3%) after dose two, compared with 11/339(3.2%) pregnant unvaccinated females. Pregnant vaccinated females had an increased odds of a significant health event...
Background Community-acquired pneumonia (CAP) causes substantial morbidity and mortality. There i... more Background Community-acquired pneumonia (CAP) causes substantial morbidity and mortality. There is a lack of data on the comprehensive burden of CAP across the life span in Canada. We estimated the incidence of all-cause CAP in all age groups in Ontario and British Columbia (BC), Canada. Methods We identified hospitalized and outpatient CAP episodes from the Discharge Abstract Database (DAD) and physician billing claims databases (Ontario Health Insurance Plan in Ontario and Medical Services Plan in BC) in both provinces. The National Ambulatory Care Reporting System was used to identify CAP episodes from emergency department visits in Ontario. CAP recorded with a primary or secondary diagnosis was identified using International Classification of Diseases 9 (480–486, 510, 513) and 10 (J10.0, J11.0, J12–J18, J86.9, J85.1) codes. We estimated the age and sex adjusted annual incidence of CAP overall, and by age groups (0–4, 5–17, 18–39, 40–64, 65–74, 75–84 and ≥85 years) according to r...
BACKGROUND Invasive pneumococcal disease (IPD) burden, evaluated in Canada using reported confirm... more BACKGROUND Invasive pneumococcal disease (IPD) burden, evaluated in Canada using reported confirmed cases in surveillance systems, is likely underestimated due to underreporting. We estimated the burden of IPD in Ontario and British Columbia (BC) by combining surveillance data with health administrative databases. METHODS We established a cohort of 27,525 individuals in Ontario and BC. Laboratory-confirmed IPD cases were identified from Ontario's integrated Public Health Information System and the BC Centre for Disease Control Public Health Laboratory. Possible IPD cases were identified from hospitalization data in both provinces, and from emergency department visit data in Ontario. We estimated the age and sex adjusted annual incidence of IPD and pneumococcal conjugate/polysaccharide vaccine (PCV/PPV) serotype-specific IPD using Poisson regression models. RESULTS In Ontario, 20,205 overall IPD cases, including 15,299 laboratory-confirmed cases, were identified with relatively stable age- and sex-adjusted annual incidence rates ranging from 13.7/100,000 (2005) to 13.6/100,000 (2018). In BC, 7,320 overall IPD cases, including 5,932 laboratory-confirmed cases were identified; annual incidence rates increased from 10.9/100,000 (2002) to 13.2/100,000 (2018). Older adults aged ≥ 85 years had the highest incidence rates. During 2007-2018 the incidence of PCV7 serotypes and additional PCV13 serotypes decreased while the incidence of unique PPV23 and non-vaccine serotypes increased in both provinces. CONCLUSIONS IPD continues to cause a substantial public health burden in Canada despite publicly funded pneumococcal vaccination programs, resulting in part from an increase in unique PPV23 and non-vaccine serotypes.
Among the 5 patients with acute tubulointerstitial nephritis, 4 were biopsy-proven, and 1 was pre... more Among the 5 patients with acute tubulointerstitial nephritis, 4 were biopsy-proven, and 1 was presumed based on the clinical history of recent NSAID use. Renal biopsies were performed in six patients, and histopathological diagnoses were pigment cast nephropathy (n=1), acute tubulointerstitial nephritis (n=4), and infection-related GN (n=1). Among the four patients with acute tubulointerstitial nephritis, two had exposures to NSAIDs and native medications, while a clear aetiology could not be identified in the other two. One patient, in addition, had the incidental finding of extramedullary haematopoiesis in the kidney, which was secondary to HIV-related bone marrow fibrosis. The overall mortality rate was 41.4% (5 patients died during hospitalisation, 7 patients died during follow-up). Seven patients remained dialysis-dependent at the time of discharge/death. Conclusions: While we identified a very vast spectrum of AKI, overwhelmingly the most common cause in our hospital population remains sepsis. A significant proportion required renal replacement therapy, and the patients in our cohort suffered a high mortality rate. Limitations include observational study design, referral bias, and small sample size.
Aim Combination vaccines decrease the number of needles required, addressing a common concern of ... more Aim Combination vaccines decrease the number of needles required, addressing a common concern of parents. However, some parents are hesitant about combination vaccines and/or want to opt out of certain vaccine components. This study assessed whether introduction of the combination MMRV vaccine influenced coverage levels for measles- and varicella-containing vaccines. Study and methods This was a population-based study of children born in Alberta, Canada between 2006 and 2012. We utilized administrative health data to evaluate coverage for the first dose of measles- and varicella-containing vaccines at the age of 24 months (i.e. between 2008 and 2014) before and after introduction of the combination MMRV vaccine in 2010. Among those who were vaccinated, we assessed whether any children continued to receive separate vaccines after the combination vaccine was introduced. Results Of 308,212 children, 272,345 (88.36%) were vaccinated with measles- and/or varicella-containing vaccines at ...
Background: Concern about adverse events following immunization is frequently cited by both those... more Background: Concern about adverse events following immunization is frequently cited by both those who receive or decline vaccines. Neurological adverse events are especially concerning. Objectives: Our aim was to detect associations between seasonal influenza vaccination and the occurrence of severe anesthesia/paresthesia or severe headaches. Methods: Data were analyzed from the Canadian National Vaccine Safety network. Events occuring on days 0-7 were self-reported and prevented daily activity, led to school or work absenteeism, or required medical attention. Controls were the previous year's vaccinees; events in controls were collected prior to the start of the influenza vaccination program of each year (2012/13 through 2016/17). Multivariable logistic regression was used to determine the association between seasonal influenza vaccination and the occurrence of anesthesia/paresthesia or severe headaches. Results: The total sample was 107,565 for investigating anesthesia/paresthesia and 97,420 for investigating severe headaches. Anesthesia/paresthesia was reported by 104/107,565 (0.10%) participants; 63/69,129 (0.09%) vaccinees and 41/38,436 (0.11%) controls (adjusted odds ratio (aOR) = 0.89; 95% CI = 0.60, 1.32). Severe headaches were reported by 1361/97,420 (1.40%) participants; 907/61,463 (1.48%) vaccinees and 454/35,957 (1.26%) controls (aOR = 1.21; 95% CI = 1.08, 1.36). No specific vaccine product was associated with severe headaches. Conclusions: Our study found no association between severe anesthesia/paresthesia and seasonal influenza vaccination. While there was an association with severe headaches as an adverse event following influenza vaccination, the rates of these events are similar to rates reported from clinical trials and are not a cause for additional concern.
In Canada, Indigenous people have higher human papillomavirus (HPV) infection rates, lower screen... more In Canada, Indigenous people have higher human papillomavirus (HPV) infection rates, lower screening rates for cervical cancer, and higher rates of invasive cancer, leading to worse cervical cancer-related outcomes than observed in non-Indigenous Canadian women. Lingering harms from European colonization drive these health inequities and create public health challenges. Policy guidance is needed to optimize HPV vaccination rates and, thereby, decrease the burden of HPV-related illness, including high-morbidity surgical procedures and chemo-radiotherapy. The Enhancing HPV Vaccination In First Nations Populations in Alberta (EHVINA) project focuses on First Nations, a diverse subset of recognized Indigenous people in Canada, and seeks to increase HPV vaccination among girls and boys living in First Nation communities. Developing an effective strategy requires partnership with affected communities to better understand knowledge and perceptions about cancer, healthcare, and the HPV vacc...
HCW were enrolled and surveyed over two seasons and > 90% reported no severe event following vacc... more HCW were enrolled and surveyed over two seasons and > 90% reported no severe event following vaccination. Validated severe event rates were similar in vaccinated HCW and unvaccinated HCW (2.2% vs 2.3%; p < 0.70). The questionnaire was accurately completed for most reported symptoms, matched the validated report and was able to detect events of interest. Prior to the safety concern, the implicated vaccine was in use at one centre. Reassuring safety data were provided to public health authorities 48 hours after the vaccine was temporarily suspended. Data from this and similar networks can be used for rapid evaluation of vaccine safety and for safety assessment as required by the European Medicines Agency in 2015.
We previously reported trends in pneumococcal nasopharyngeal carriage in the post-PCV13 era as de... more We previously reported trends in pneumococcal nasopharyngeal carriage in the post-PCV13 era as detected by conventional culture methods. Our current aim is to assess if there are fundamental differences in the clinical and demographic features of children who have pneumococcal carriage detected by qPCR compared with culture analysis. The CASPER team conducted point-prevalence surveys in 2016 in healthy children in Calgary to determine trends in overall and serotype-specific pneumococcal nasopharyngeal carriage. Being 18 months of age (p = 0.009), having at least one sibling under 2 years of age (p = 0.04), having only sibling(s) over 2 years of age (p = 0.001), and childcare attendance (p = 0.005) were associated with carriage by qPCR methods only. Having only sibling(s) older than 2 years of age was associated with carriage detected by both qPCR and culture methods (p = 0.001). No clinical factors were associated with carriage detected by both qPCR and culture compared to qPCR meth...
OBJECTIVE: To provide evidence-based recommendations for classification, diagnosis and treatment ... more OBJECTIVE: To provide evidence-based recommendations for classification, diagnosis and treatment of acute, chronic and recurrent acute sinusitis in adults and children.DATA SOURCES: Review articles, textbooks, other published guidelines and recommendations of task force members.STUDY SELECTION: One hundred and seventy-one papers addressing one or all of the objectives.DATA EXTRACTION: Relevant data were collated under each objective.DATA SYNTHESIS: Validity of diagnostic and treatment evidence was assessed by using the methodological recommendations of Sackett et al and the canadian Task Force on Periodic Health Examination, respectively. Where there was a paucity of data, consensus of task force members was reached.CONCLUSIONS: Sinusitis is classified as acute, chronic or recurrent acute disease according to duration and frequency of symptoms and response to therapy (expert opinion). Potential risk factors, concomitant diseases and complications are identified (limited evidence). D...
Background: The epidemiology of pediatric bloodstream infection has not been well defined in gene... more Background: The epidemiology of pediatric bloodstream infection has not been well defined in general populations. The primary objective of this study was to describe the burden of illness of pediatric bloodstream infections in a large Canadian region and secondarily to assess the effect of implementation of universal infant immunization with 7-valent pneumococcal conjugate vaccine (PCV7) in 2002. Methods: Surveillance for all bloodstream infections was conducted among pediatric (Ͻ18 years) residents of the Calgary Health Region during 2000-2006. Results: Nine hundred ninety-five episodes of bloodstream infection occurred for an overall annual incidence of 53.7 per 100,000. Forty-eight percent were community-acquired, 27% were nosocomial-acquired, and 26% were healthcare-associated community onset. The risk for bloodstream infection was highest in neonates. The annual incidence of bloodstream infection changed significantly (P Ͻ 0.001) and was attributed to a decreasing incidence of community (P ϭ 0.001) acquired disease. The most common species isolated were Streptococcus pneumoniae, Staphylococcus aureus, and Escherichia coli. Overall rates of pneumococcal infection decreased significantly in the post-PCV7 era (2004-2006) as compared with pre-PCV7 era (2000-2001) (4.6 vs. 13.6 per 100,000; P Ͻ 0.0001). This was even more pronounced in the subset with community-acquired disease (3.0 vs. 11.3 per 100,000; P Ͻ 0.0001) especially in the age group between 1 and 23 months of age (7.3 vs. 58.9 per 100,000; P Ͻ 0.0001). The overall mortality rate was 2 per 100,000/yr. Conclusions: Bloodstream infections are an important cause of disease in children. Implementation of PCV7 has been associated with a significant reduction in the overall burden of disease.
Background The Canadian National Vaccine Safety (CANVAS) network monitors the safety of seasonal ... more Background The Canadian National Vaccine Safety (CANVAS) network monitors the safety of seasonal influenza vaccines in Canada. Aim To provide enhanced surveillance for seasonal influenza and pandemic influenza vaccines. Methods In 2017/18 and 2018/19 influenza seasons, adults (≥ 15 years of age) and parents of children vaccinated with the seasonal influenza vaccine participated in an observational study using web-based active surveillance. Participants completed an online survey for health events occurring in the first 7 days after vaccination. Participants who received the influenza vaccine in the previous season, but had not yet been vaccinated for the current season, were unvaccinated controls. Results In 2017/18, 43,751 participants and in 2018/19, 47,798 completed the online safety survey. In total, 957 of 30,173 participants vaccinated in 2017/18 (3.2%; 95% confidence interval (CI): 3.0–3.4) and 857 of 25,799 participants vaccinated in 2018/19 (3.3%; 95% CI: 3.1–3.5) reported ...
Pediatrician and pediatric subspecialist density varies substantially among the various Canadian ... more Pediatrician and pediatric subspecialist density varies substantially among the various Canadian provinces, as well as among various states in the US. It is unknown whether this variability impacts health outcomes. To study this knowledge gap, we evaluated pediatric asthma admission rates within the 2 Canadian provinces of Manitoba and Saskatchewan, which have similarly sized pediatric populations and substantially different physician densities. This was a retrospective cross-sectional cohort study. Health regions defined by the provincial governments, have, in turn, been classified into "peer groups" by Statistics Canada, on the basis of common socio-economic characteristics and socio-demographic determinants of health. To study the relationship between the distribution of the pediatric workforce and health outcomes in Canadian children, asthma admission rates within comparable peer group regions in both provinces were examined by combining multiple national and provincia...
BACKGROUND: Antibiotics are commonly used in pediatrics in both community and hospital settings. ... more BACKGROUND: Antibiotics are commonly used in pediatrics in both community and hospital settings. To date, no study has examined antibiotic choices in Canada or in the USA by Pediatric Residents (PR) and recently graduated Pediatricians (RGP). OBJECTIVE: To describe the antibiotic choices made by PR and RGP for common infectious disease problems in children. PARTICIPATION AND METHODS: PR who are currently involved in 13 Canadian Pediatric PostGraduate Programs and RGP practicing in Canada for less than 5 years were mailed a questionnaire describing 10 common pediatric infectious disease clinical scenarios. RESULTS: 251/552 (45.5%) participants completed the survey of which 129/273 were PR (47.3%) and 122/279 (43.7%) were RGP. The following results were found in clinical cases where practice guidelines exist: Suggested antibiotics by respondents PR RGP Total
Background: Since the introduction of childhood pneumococcal conjugate vaccines, invasive pneumoc... more Background: Since the introduction of childhood pneumococcal conjugate vaccines, invasive pneumococcal disease (IPD) incidence has decreased in children and the predominant serotypes causing disease have changed. This study describes changes in the clinical features of IPD in children (<18 years) before and after the conjugate vaccine introduction. Methods: The Calgary Area Streptococcus pneumoniae Epidemiology Research study collects information on all IPD cases in Calgary, Alberta, Canada. Descriptive and regression analyses were used to compare IPD in the pre-vaccine (January 2000 to August 2002), post-7-valent protein-polysaccharide conjugate vaccine (September 2002 to June 2010) and post-13-valent protein-polysaccharide conjugate vaccine (PCV13) (July 2010 to December 2015) periods; intensive care unit and inpatient admissions were outcome measures. Results: The incidence of IPD in children (<18 years) decreased from an average of 17 cases/100,000/yr in 2000–2001 to 4 cases/100,000/yr in 2015. The median age of children presenting with IPD shifted from 2.0 years (interquartile range: 2.5) in the pre-vaccine period to 3.9 years (interquartile range: 6.2) in the post-PCV13 period. The proportion of children with a comorbidity that is an indication for pneumococcal vaccination did not change. Invasive disease with focus (meningitis, pneumonia, empyema, peritonitis) compared with invasive disease with bacteremia only increased from 44.6% in pre-vaccine to 64.0% and 61.4% in the post-7-valent protein-polysaccharide conjugate vaccine and post-PCV13 periods, respectively (P = 0.017). Having IPD in the post-PCV13 period compared with the pre-vaccine period was associated with an increased odds of hospitalization [Odds ratio (OR): 2.9; 95% Confidence Interval (CI): 1.4–6.2]. Conclusions: Clinical features of IPD have changed since pneumococcal conjugate vaccines were introduced, with a shift toward more focal infections requiring hospitalization. Although overall IPD cases have declined, disease that does occur appears to be more severe.
Canadian journal of public health = Revue canadienne de sante publique, Jan 16, 2017
Assessing timeliness and completeness of vaccine administration is important for evaluating the e... more Assessing timeliness and completeness of vaccine administration is important for evaluating the effectiveness of immunization programs. Few studies have reported timeliness, particularly in Canada. The objective of this study was to examine timeliness of the receipt of vaccination for each routine childhood recommended vaccine by 24 months of age among children in a community-based pregnancy cohort in Calgary, Alberta. Survey data from a community-based pregnancy cohort in Alberta were linked to Public Health vaccination records of children (n = 2763). The proportion of children receiving early, timely, delayed, or no vaccination was calculated. A dose was considered early if it was administered before the recommended age in days as per the vaccination schedule, timely if administered at any time from start of recommended age in days to age in days when delay counts were initiated, and delayed if it was administered on or after age in days when delay counts were initiated. Series co...
The diversity of Canadian infant meningococcal C conjugate (MenC) vaccine programs is unique amon... more The diversity of Canadian infant meningococcal C conjugate (MenC) vaccine programs is unique among countries providing MenC vaccines and offers a valuable opportunity to determine the optimal vaccine program. This longitudinal study assessed differences in sero-protection by three different vaccine schedules in children 2 years after receiving either one toddler MenC vaccine dose (one dose), one infant and one toddler dose (two dose), or two infant and one toddler MenC vaccine dose (three dose). Three similar cohorts of healthy infants from one, two and three dose program areas were enrolled before to their 12 month toddler dose and vaccinated with MenC-tetanus toxoid (MenC-TT) conjugate vaccine. Sera obtained 2 years later were assayed for serogroup C bactericidal activity using standardized procedures with rabbit as the exogenous complement source. Serum bactericidal activity titers &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 1:8 were considered protective. Results were available for 384 children. Rates of sero-protection at 36 months of age were significantly different between the one and three dose programs, but confidence intervals overlapped between the one and two dose programs and between the two and three dose programs: one dose 92% (95% CI 86% - 96%) vs. 99% (95%-100%) with two doses and 100% (97% - 100%) with three doses. Geometric mean titers were significantly different at 12.1 (10.8-13.5), 32.4 (28.9-36.2) and 50.6 (45.7-55.9) in the one, two and three dose programs respectively. At 36 months of age, evidence of sero-protection remained for greater than 90% of participants. Our results indicate that one toddler dose or one infant plus one toddler dose with MenC-TT vaccine provides sero-protection against MenC disease in early childhood.
During the Sars-CoV-2 pandemic in 2020, many countries shut down schools and businesses in an eff... more During the Sars-CoV-2 pandemic in 2020, many countries shut down schools and businesses in an effort to slow transmission of the virus. As some businesses reopened, increased public health protocols, mask wearing, hand sanitizer, and personal protective equipment use remained. The shut down and public health restrictions for person-to-person interaction, resulted in a decline of other transmissible diseases as well as Sars-CoV-2. In Calgary, the incidence of invasive disease due to Streptococcus pneumoniae declined to much lower levels than would be expected in early spring and remained low until December 2020. This decline occurred despite no changes in vaccine use and uptake.
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Papers by James Kellner