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Fakhraei R, Erwin E, Alibhai KM, Murphy MSQ, Dingwall-Harvey ALJ, White RR, Dimanlig-Cruz S, LaRose R, Grattan K, Jia JJ, Liu G, Arnold C, Galipeau Y, Shir-Mohammadi K, Alton GD, Dy J, Walker MC, Fell DB, Langlois MA, El-Chaâr D. Prevalence of SARS-CoV-2 infection among obstetric patients in Ottawa, Canada: a descriptive study. CMAJ Open 2022; 10:E643-E651. [PMID: 35820683 PMCID: PMC9328441 DOI: 10.9778/cmajo.20210228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is limited information on the prevalence of SARS-CoV-2 infection in obstetric settings in Canada, beyond the first wave of the COVID-19 pandemic (February to June 2020). We sought to describe the prevalence of SARS-CoV-2 infection in pregnant people admitted to triage units at a tertiary care hospital in Ottawa, Canada. METHODS We conducted a descriptive study of pregnant people admitted to obstetric triage assessment units at The Ottawa Hospital between Oct. 19 and Nov. 27, 2020 (second local wave of the COVID-19 pandemic). Participants underwent SARS-CoV-2 polymerase chain reaction (PCR) (via naso- or oropharyngeal swabs) and serology testing upon admission. We excluded individuals younger than 18 years, those who did not speak English or French, those who enrolled in conflicting studies, those admitted for pregnancy termination and those triaged between 11:31 pm and 7:29 am. Swab and serology samples were analyzed using digital droplet PCR and enzyme-linked immunosorbent assays, respectively. We defined SARS-CoV-2 seropositivity as a positive result for immunoglobulin (Ig) G, either alone or in combination with IgM or IgA. RESULTS Of the 632 eligible patients, 363 (57.4%) consented to participation and 362 collectively provided 284 swab and 352 blood samples eligible for analysis. Common reasons for declining participation included feeling overwhelmed or anxious, being worried about repercussions of testing, pain or discomfort with testing or disinterest in research. Participants were mostly multiparous (53.9%) and in their third trimester upon admission (88.4%). In all, 18 (4.9%) participants had evidence of SARS-CoV-2 exposure; 2 (0.7%) of 284 were positive for SARS-CoV-2 by PCR and 16 (4.5%) of 352 were positive for IgG antibodies to SARS-CoV-2. INTERPRETATION During the second local wave of the COVID-19 pandemic, the prevalence of active SARS-CoV-2 infection among obstetric patients in Ottawa was 0.7% and seroprevalence was 4.5%. Our low participation rate highlights the need for improvements in patient education and public health messaging on the benefits of SARS-CoV-2 testing programs.
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Affiliation(s)
- Romina Fakhraei
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Erica Erwin
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Kameela M Alibhai
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Malia S Q Murphy
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Alysha L J Dingwall-Harvey
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Ruth Rennicks White
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Sheryll Dimanlig-Cruz
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Rosemary LaRose
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Kimberly Grattan
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Jian-Jun Jia
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - George Liu
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Corey Arnold
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Yannick Galipeau
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Khatereh Shir-Mohammadi
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Gillian D Alton
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Jessica Dy
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Mark C Walker
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Deshayne B Fell
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Marc-André Langlois
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont
| | - Darine El-Chaâr
- OMNI Research Group (Fakhraei, Erwin, Alibhai, Murphy, Dingwall-Harvey, Rennicks White, Dimanlig-Cruz, LaRose, Grattan, Walker, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Fakhraei, Walker, Fell, El-Chaâr), University of Ottawa; Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fell); Better Outcomes Registry & Network (Erwin, Dimanlig-Cruz, Alton, Walker); Faculty of Medicine (Alibhai, El-Chaâr), University of Ottawa; Department of Obstetrics, Gynecology, and Newborn Care (Rennicks White, Walker, El-Chaâr), The Ottawa Hospital; Departments of Biochemistry, Microbiology and Immunology (Jia, Liu, Arnold, Galipeau, Shir-Mohammadi, Langlois), Obstetrics and Gynecology (Dy, Walker, El-Chaâr), and International and Global Health Office (Dy, Walker), University of Ottawa, Ottawa, Ont.
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