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Fitzpatrick T, Alsager K, Sadarangani M, Pham-Huy A, Murguía-Favela L, Morris SK, Seow CH, Piché-Renaud PP, Jadavji T, Vanderkooi OG, Top KA, Constantinescu C. Immunological effects and safety of live rotavirus vaccination after antenatal exposure to immunomodulatory biologic agents: a prospective cohort study from the Canadian Immunization Research Network. Lancet Child Adolesc Health 2023; 7:648-656. [PMID: 37390832 DOI: 10.1016/s2352-4642(23)00136-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND People with inflammatory or autoimmune diseases are recommended to continue immunomodulatory biologic agents throughout pregnancy. However, concerns regarding potential immunosuppression in infants exposed to biologic agents have led to recommendations to avoid live vaccines in the first 6-12 months of life. We aimed to examine whether live rotavirus vaccine could be administered safely to infants exposed to biologic agents, assessed in the Canadian Special Immunization Clinic (SIC) Network. METHODS In this prospective cohort study, infants exposed to biologic agents in utero were referred to one of six SIC sites in Canada for rotavirus vaccination recommendations. Children with other contraindications to rotavirus vaccination or older than 15 weeks were excluded. Clinical and laboratory evaluations were conducted according to a standard clinical pathway. Data were collected for relevant medical history, pregnancy outcomes, biologic agent exposure history, physical examination, laboratory results of the child, SIC recommendations for rotavirus vaccination, rotavirus vaccine series completion, and adverse events after immunisation. After parental consent, deidentified data were transferred to a central database for analysis. Children recommended for rotavirus vaccination were followed up for 8 months after series initiation to ascertain severe and serious adverse events, including severe diarrhoea, vomiting, and intussusception. FINDINGS Between May 1, 2017, and Dec 31, 2021, 202 infants were assessed and 191 eligible infants were enrolled (97 [51%] were female and 94 [49%] were male). When including those exposed to multiple agents, the most common biologic agents to which infants were exposed were infliximab (67 [35%] of 191), adalimumab (49 [26%]), ustekinumab (18 [9%]), and vedolizumab (17 [9%]). Biologic agent exposure continued into the third trimester for 178 (93%) infants. No clinically significant abnormalities in lymphocyte subsets, quantitative immunoglobulins, or mitogen responses were detected. After SIC assessment, rotavirus vaccination was recommended for 187 (98%) of 191 infants, all of whom were followed up. By end of follow-up on Aug 19, 2022, 168 (90%) infants had initiated rotavirus vaccination; 150 (80%) completed the series. No serious adverse events after immunisation were reported, but three (2%) infants required medical attention, one for vomiting and change in stools who was subsequently diagnosed with gastroesophageal reflux disease, one for rash on labia unrelated to vaccination, and one for vomiting and diarrhoea associated with a milk allergy. INTERPRETATION Findings from this study suggest that lymphocyte subsets and the safety of live rotavirus vaccination are generally not affected by in-utero exposure to biologic agents. Rotavirus vaccination can be offered to infants exposed to anti-TNF agents in utero. FUNDING Public Health Agency of Canada and Canadian Institutes of Health Research through the Canadian Immunization Research Network.
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Affiliation(s)
- Tiffany Fitzpatrick
- Canadian Center for Vaccinology, IWK Health, Halifax, NS, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Khaled Alsager
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Pediatric Infectious Diseases Division, Pediatric Department, King Abdullah Specialized Children's Hospital, Ministry of National Guard Hospital Affairs, Riyadh, Saudi Arabia
| | - Manish Sadarangani
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Anne Pham-Huy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Luis Murguía-Favela
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Shaun K Morris
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Cynthia H Seow
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Tajdin Jadavji
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Otto G Vanderkooi
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, IWK Health, Halifax, NS, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada; Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
| | - Cora Constantinescu
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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Xie J, Kim K, Berenger BM, Chui L, Vanderkooi OG, Grisaru S, Freedman SB. Comparison of a Rapid Multiplex Gastrointestinal Panel with Standard Laboratory Testing in the Management of Children with Hematochezia in a Pediatric Emergency Department: Randomized Controlled Trial. Microbiol Spectr 2023; 11:e0026823. [PMID: 37039648 PMCID: PMC10269456 DOI: 10.1128/spectrum.00268-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/10/2023] [Indexed: 04/12/2023] Open
Abstract
Advances in diagnostic microbiology allow for the rapid identification of a broad range of enteropathogens; such knowledge can inform care and reduce testing. We conducted a randomized, unblinded trial in a tertiary-care pediatric emergency department. Participants had stool (and rectal swabs if stool was not immediately available) tested using routine microbiologic approaches or by use of a device (BioFire FilmArray gastrointestinal panel), which identifies 22 pathogens with a 1-h instrument turnaround time. Participants were 6 months to <18.0 years and had acute bloody diarrhea. Primary outcome was performance of blood tests within 72 h. From 15 June 2018 through 7 May 2022, 60 children were randomized. Patients in the BioFire FilmArray arm had a reduced time to test result (median 3.0 h with interquartile range [IQR] of 3.0 to 4.0 h, versus 42.0 h (IQR 23.5 to 47.3 h); difference of -38.0 h, 95% confidence interval [CI] of -41.0 to -22.0 h). Sixty-five percent (20/31) of participants in the BioFire FilmArray group had a pathogen detected-most frequently enteropathogenic Escherichia coli (19%), Campylobacter (16%), and Salmonella (13%). Blood tests were performed in 52% of children in the BioFire FilmArray group and 62% in the standard-of-care group (difference of -10.5%, 95% CI of -35.4% to 14.5%). There were no between-group differences in the proportions of children administered intravenous fluids, antibiotics, hospitalized, or who had diagnostic imaging performed. Testing with the BioFire FilmArray reduced the time to result availability by 38 h. Although statistical significance was limited by study power, BioFire FilmArray use was not associated with clinically meaningful reductions in health care utilization or improved outcomes. IMPORTANCE Advances in diagnostic microbiology now allow for the faster and more accurate detection of an increasing number of pathogens. We determined, however, that in children with acute bloody diarrhea, these advances did not necessarily translate into improved clinical outcomes. While a greater number of pathogens was identified using a rapid turnaround multiplex stool diagnostic panel, with a reduction in the time to stool test result of over 1.5 days, this did not alter the practice of pediatric emergency medicine physicians, who continued to perform blood tests on a large proportion of children. While our conclusions may be limited by the relatively small sample size, targeted approaches that educate clinicians on the implementation of such technology into clinical care will be needed to optimize usage and maximize benefits.
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Affiliation(s)
- Jianling Xie
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Byron M. Berenger
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Precision Laboratories, Alberta Health Services, Calgary, Alberta, Canada
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories, Alberta Health Services, Edmonton, Alberta, Canada
| | - Otto G. Vanderkooi
- Section of Infectious Diseases, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Silviu Grisaru
- Section of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephen B. Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Pediatric Gastroenterology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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3
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Bettinger JA, Irvine MA, Shulha HP, Valiquette L, Muller MP, Vanderkooi OG, Kellner JD, Top KA, Sadarangani M, McGeer A, Isenor JE, Marty K, Soe P, De Serres G. Adverse Events Following Immunization With mRNA and Viral Vector Vaccines in Individuals With Previous Severe Acute Respiratory Syndrome Coronavirus 2 Infection From the Canadian National Vaccine Safety Network. Clin Infect Dis 2023; 76:1088-1102. [PMID: 36310514 PMCID: PMC9620384 DOI: 10.1093/cid/ciac852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Adults previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develop short-term immunity and may have increased reactogenicity to coronavirus disease 2019 (COVID-19) vaccines. This prospective, multicenter, active-surveillance cohort study examined the short-term safety of COVID-19 vaccines in adults with a prior history of SARS-CoV-2. METHODS Canadian adults vaccinated between 22 December 2020 and 27 November 2021 were sent an electronic questionnaire 7 days post-dose 1, dose 2, and dose 3 vaccination. The main outcome was health events occurring in the first 7 days after each vaccination that prevented daily activities, resulted in work absenteeism, or required a medical consultation, including hospitalization. RESULTS Among 684 998 vaccinated individuals, 2.6% (18 127/684 998) reported a prior history of SARS-CoV-2 infection a median of 4 (interquartile range: 2-6) months previously. After dose 1, individuals with moderate (bedridden) to severe (hospitalized) COVID-19 who received BNT162b2, mRNA-1273, or ChAdox1-S vaccines had higher odds of a health event preventing daily activities, resulting in work absenteeism or requiring medical consultation (adjusted odds ratio [95% confidence interval]: 3.96 [3.67-4.28] for BNT162b2, 5.01 [4.57-5.50] for mRNA-1273, and 1.84 [1.54-2.20] for ChAdox1-S compared with no infection). Following dose 2 and 3, the greater risk associated with previous infection was also present but was attenuated compared with dose 1. For all doses, the association was lower or absent after mild or asymptomatic infection. CONCLUSIONS Adults with moderate or severe previous SARS-CoV-2 infection were more likely to have a health event sufficient to impact routine activities or require medical assessment in the week following each vaccine dose.
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Affiliation(s)
- Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | | | - Hennady P Shulha
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Louis Valiquette
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Otto G Vanderkooi
- Department of Pediatrics and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - James D Kellner
- Department of Pediatrics and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, IWK Health and Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Allison McGeer
- Sinai Health System and University of Toronto, Toronto, Canada
| | - Jennifer E Isenor
- College of Pharmacy and Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
| | - Kimberly Marty
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
| | - Phyumar Soe
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
| | - Gaston De Serres
- CHU de Québec-Université Laval, Quebec City, Canada
- Institut National de Santé Publique du Québec, Quebec City, Canada
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Böhrer M, Fitzpatrick E, Hurley K, Xie J, Lee BE, Pang X, Zhuo R, Parsons BD, Berenger BM, Chui L, Tarr PI, Ali S, Vanderkooi OG, Freedman SB, Zemek R, Newton M, Meckler G, Poonai N, Bhatt M, Maki K, McGahern C, Emerton R. Hematochezia in children with acute diarrhea seeking emergency department care - a prospective cohort study. Acad Emerg Med 2022; 29:429-441. [PMID: 34962688 DOI: 10.1111/acem.14434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/07/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Although the passage of blood in stools in children represents a medical emergency, children seeking emergency department (ED) care remain poorly characterized. Our primary objective was to compare clinical characteristics and etiologic pathogens in children with acute diarrhea with and without caregiver-reported hematochezia. Secondary objectives were to characterize interventions and resource utilization. METHODS We conducted a secondary analysis of the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) database. Children <18 years presenting to two pediatric EDs within a 24-hour period and <7 days of symptoms were consecutively recruited. RESULTS Of 1,061 participants, 115 (10.8%) reported hematochezia at the enrollment visit at which time those with hematochezia, compared to those without, had more diarrheal episodes/24-hour period (9 vs. 6; difference: 2; 95% confidence interval [CI]: 2.0, 4.0; p < 0.001), and were less likely to have experienced vomiting (54.8% vs. 80.2%; difference: -25.4; 95% CI: -34.9, -16.0; p < 0.001). They were more likely to receive intravenous fluids (33.0% vs. 17.9%; difference: 15.2; 95% CI: 6.2, 24.1; p < 0.001) and require repeat health care visits (45.5% vs. 34.7%; difference: 10.7; 95% CI: 0.9, 20.6; p = 0.03). A bacterial pathogen was identified in 33.0% of children with hematochezia versus 7.9% without (difference: 25.1; 95% CI: 16.3, 33.9; p < 0.001); viruses were detected in 31.3% of children with hematochezia compared to 72.3% in those without (difference: -41.0%, 95% CI: -49.9, -32.1; p < 0.001). CONCLUSION In children with acute diarrhea, caregiver report of hematochezia, compared to the absence of hematochezia, was associated with more diarrheal but fewer vomiting episodes, and greater resource consumption. The former group of children was also more likely to have bacteria detected in their stool.
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Affiliation(s)
| | | | | | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary Calgary Canada
| | - Bonita E. Lee
- Departments of Pediatrics & Emergency Medicine Faculty of Medicine & Dentistry Women and Children's Health Research Institute University of Alberta Edmonton Alberta Canada
| | - Xiao‐Li Pang
- Department of Laboratory Medicine and Pathology University of Alberta Edmonton Canada
| | - Ran Zhuo
- Department of Laboratory Medicine and Pathology University of Alberta Edmonton Canada
| | | | - Byron M. Berenger
- Department of Pathology and Laboratory Medicine University of Calgary Calgary Canada
| | - Linda Chui
- Department of Laboratory Medicine and Pathology University of Alberta Edmonton Canada
| | | | - Samina Ali
- Department of Laboratory Medicine and Pathology University of Alberta Edmonton Canada
| | - Otto G. Vanderkooi
- Section of Pediatric Infectious Diseases. Departments of Pediatrics; Microbiology, Immunology & Infectious Diseases; Pathology and Laboratory Medicine; and Community Health Sciences University of Calgary Alberta Children’s Hospital Research Institute Calgary Canada
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology Departments of Pediatrics and Emergency Medicine Alberta Children’s Hospital and the Alberta Children’s Hospital Research Institute Cumming School of Medicine University of Calgary Calgary Canada
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5
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Murad Y, Hung TY, Sadarangani M, Morris SK, Le Saux N, Vanderkooi OG, Kellner JD, Tyrrell GJ, Martin I, Demczuk W, Halperin SA, Bettinger JA. Clinical Presentations and Outcomes of Children in Canada With Recurrent Invasive Pneumococcal Disease From the IMPACT Surveillance Network. Pediatr Infect Dis J 2022; 41:e166-e171. [PMID: 35093996 PMCID: PMC8920017 DOI: 10.1097/inf.0000000000003454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Invasive pneumococcal disease due to Streptococcus pneumoniae can cause mortality and severe morbidity due to sepsis, meningitis and pneumonia, particularly in young children and the elderly. Recurrent invasive pneumococcal disease is rare yet serious sequelae of invasive pneumococcal disease that is associated with the immunocompromised and leads to a high mortality rate. METHOD This retrospective study reviewed recurrent invasive pneumococcal disease cases from the Canadian Immunization Monitoring Program, ACTive (IMPACT) between 1991 and 2019, an active network for surveillance of vaccine-preventable diseases and adverse events following immunization for children ages 0-16 years. Data were collected from 12 pediatric tertiary care hospitals across all 3 eras of public pneumococcal conjugate vaccine implementation in Canada. RESULTS The survival rate within our cohort of 180 recurrent invasive pneumococcal disease cases was 98.3%. A decrease of 26.4% in recurrent invasive pneumococcal disease due to vaccine serotypes was observed with pneumococcal vaccine introduction. There was also a 69.0% increase in the rate of vaccination in children with preexisting medical conditions compared with their healthy peers. CONCLUSION The decrease in recurrent invasive pneumococcal disease due to vaccine-covered serotypes has been offset by an increase of non-vaccine serotypes in this sample of Canadian children.
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Affiliation(s)
- Yousif Murad
- From the Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Te-Yu Hung
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
- Royal Darwin Hospital, Top End Health Service, Northern Territory, Australia
- Royal Melbourne Hospital, Doherty Institute for Infection Immunity, Victoria, Australia
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Shaun K. Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Nicole Le Saux
- Children’s Hospital of Eastern Ontario, Paediatric Infectious Disease, Ottawa, ON, Canada
| | - Otto G. Vanderkooi
- Departments of Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - James D. Kellner
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Gregory J. Tyrrell
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
- Alberta Precision Laboratories-Public Health, Edmonton, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Scott A. Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, and Nova Scotia Health, Halifax, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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Bettinger JA, Sadarangani M, De Serres G, Valiquette L, Vanderkooi OG, Kellner JD, Muller MP, Top KA, Isenor JE, McGeer A, Marty K. The Canadian National Vaccine Safety Network: surveillance of adverse events following immunisation among individuals immunised with the COVID-19 vaccine, a cohort study in Canada. BMJ Open 2022; 12:e051254. [PMID: 35058258 PMCID: PMC8783966 DOI: 10.1136/bmjopen-2021-051254] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/05/2022] Open
Abstract
INTRODUCTION COVID-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 ANALYSIS Online 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 DISSEMINATION Each 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 Calgary and Alberta Health Services, IWK Health, Unity Health Toronto and CHU de Québec-Université Laval Research Ethics Boards). Individuals are invited to participate in this active surveillance and electronic consent is given before proceeding to each survey. Weekly reports are shared with public health and posted on the study website. At least one peer-reviewed manuscript is produced.
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Affiliation(s)
- Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Louis Valiquette
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Otto G Vanderkooi
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - James D Kellner
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Matthew P Muller
- Medicine, Unity Health Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jennifer E Isenor
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Allison McGeer
- University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Kimberly Marty
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Ma K, Ali S, Xie J, Maki C, Lee B, Chui L, Pang XL, Zhuo R, Parsons B, Vanderkooi OG, Poonai N, MacDonald SE, Tarr P, Freedman S. 144 Characterizing the Pain Experience of Children with Acute Gastroenteritis Based on Identified Pathogens. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.114] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Primary Subject area
Emergency Medicine - Paediatric
Background
Many children with acute gastroenteritis (AGE) experience moderate-to-severe pain. To date, the relationship between specific enteropathogens and pain intensity in children with AGE is poorly characterized.
Objectives
To describe pain severity experienced by children with AGE, by enteropathogen type (i.e., bacteria, virus, co-detection) during the 24 hours prior to emergency department (ED) presentation and while in the ED. We also sought to describe analgesic medication use in AGE.
Design/Methods
Children 0 to under 18 years with symptoms of AGE (vomiting and/or diarrhea, less than 7 days duration) were prospectively recruited in two pediatric EDs from December 2014 to August 2018. Rectal swabs and stool specimens were analyzed with a commercial enteric panel, an in-house viral panel, and standard enteric bacterial culture. Pain severity was reported by caregivers, with input from the child whenever possible, using a validated 11-point Verbal Numerical Rating Scale from 0 (no pain) to 10 (maximum pain).
Results
2686 children with AGE participated in the study. The overall maximal mean pain score was 5.50 (SD 3.00) during the 24 hours preceding the ED visit. Children with bacteria detected in their stool had a significantly higher mean pain score (difference: 1.10 [95% CI: 0.36, 1.84]) prior to ED visit and 1.32 (95% CI: 0.54, 2.10) while in the ED, compared to those with no pathogen identified. They also had significantly higher mean pain scores (difference: 1.10 [95%CI: 0.39, 1.81]) prior to ED visit and 1.44 (95%CI: 0.69, 2.20) while in the ED when compared to AGE caused by a single virus. Using a multivariable regression model, the association between pain severity and enteropathogen type was no longer demonstrated; however, longer illness duration (p=0.01), fever (p < 0.0001), increased number of diarrheal (p < 0.0001) and vomiting (p=0.03) episodes, and respiratory symptoms (p=0.03) were all associated with greater pain at home. Overall, analgesic use was low, with 41.6% (1117/2686) and 20.0% (538/2686) of participants receiving an analgesic at home and in the ED, respectively.
Conclusion
Enteropathogen type was not predictive of greater pain severity after adjustment for clinical symptoms (i.e., vomiting and diarrhea). The clinical constellation of symptoms accompanying any particular pathogen may differ between pathogens, and this clinical picture may play the greater role in pain experience. Analgesic use was low in children with this painful condition.
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Affiliation(s)
| | | | | | | | | | | | - Xiao-Li Pang
- Alberta Precision Laboratories-ProvLab, University of Alberta
| | | | | | | | | | | | | | - Stephen Freedman
- Alberta Children’s Hospital Research Institute University of Calgary
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8
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Tougas SR, Lodha N, Vandermeer B, Lorenzetti DL, Tarr PI, Tarr GAM, Chui L, Vanderkooi OG, Freedman SB. Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children: A Systematic Review and Meta-analysis. JAMA Pediatr 2021; 175:e212328. [PMID: 34338715 PMCID: PMC8329794 DOI: 10.1001/jamapediatrics.2021.2328] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/27/2022]
Abstract
IMPORTANCE Detection of Clostridioides difficile has frequently been described in asymptomatic infants and children, but accurate estimates across the age spectrum are unavailable. OBJECTIVE To assess the prevalence of C difficile detection among asymptomatic children across the age spectrum. DATA SOURCES This systematic review and meta-analysis included a search of the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Scopus, and Web of Science for articles published from January 1, 1990, to December 31, 2020. Search terms included Clostridium difficile, Peptoclostridium difficile, Clostridioides difficile, CDF OR CDI OR c diff OR c difficile, Clostridium infections OR cd positive diarrhea OR cd positive diarrhea OR Clostridium difficile OR Peptoclostridium difficile OR pseudomembranous colitis OR pseudomembranous enterocolitis, enterocolitis, and pseudomembranous. These were combined with the following terms: bacterial colonization and colonization OR colonized OR colonizing OR epidemiology OR prevalence OR seroprevalence. STUDY SELECTION Studies were screened independently by 2 authors. Studies were included if they reported testing for C difficile among asymptomatic children (ie, children without diarrhea) younger than 18 years. DATA EXTRACTION AND SYNTHESIS Data were extracted independently and in duplicate by 2 reviewers. Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were used. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES The primary outcome was prevalence of C difficile detection among asymptomatic children. Secondary outcomes included prevalence of toxigenic vs nontoxigenic strains of C difficile and prevalence of C difficile detection stratified by geographic region, income status, testing method, and year of testing. RESULTS A total of 95 studies with 19 186 participants were included. Rates of detection of toxigenic or nontoxigenic C difficile were greatest among infants aged 6 to 12 months (41%; 95% CI, 32%-50%) and decreased to 12% (95% CI, 7%-18%) among children aged 5 to 18 years. The prevalence of toxigenic C difficile colonization was lower, peaking at 14% (95% CI, 8%-21%) among infants aged 6 to 12 months and decreasing to 6% (95% CI, 2%-11%) among children older than 5 years. Although prevalence differed by geographic region (ie, North and South America vs Europe: β, -0.151, P = .001; North and South America vs Western Pacific: β, 0.136, P = .007), there was no difference by testing method (ie, culture vs polymerase chain reaction: β, 0.069, P = .052; culture vs enzyme immunoassay: β, -0.178, P = .051), income class (low-middle income vs high income: β, -0.144, P = .23; upper-middle vs high income: β, -0.020, P = .64), or period (before 1990 vs 2010-2020: β, -0.125, P = .19; 1990-1999 vs 2010-2020: β, -0.037, P = .42; 2000-2009 vs 2010-2020: β, -0.006, P = .86). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, C difficile colonization rates among children were greatest at 6 to 12 months of age and decreased thereafter. These estimates may provide context for interpreting C difficile test results among young children.
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Affiliation(s)
- Sarah R Tougas
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Nidhi Lodha
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences and the Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Phillip I Tarr
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri.,Department of Molecular Microbiology, Washington University in St Louis, St Louis, Missouri
| | - Gillian A M Tarr
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Otto G Vanderkooi
- Alberta Children's Hospital, Division of Pediatric Infectious Disease, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Microbiology, Immunology and Infectious Diseases, Community Health Sciences, and Pathology & Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephen B Freedman
- Alberta Children's Hospital, Divisions of Pediatric Emergency Medicine and Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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9
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Jones JL, Tse F, Carroll MW, deBruyn JC, McNeil SA, Pham-Huy A, Seow CH, Barrett LL, Bessissow T, Carman N, Melmed GY, Vanderkooi OG, Marshall JK, Benchimol EI. Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)-Part 2: Inactivated Vaccines. J Can Assoc Gastroenterol 2021; 4:e72-e91. [PMID: 34476339 PMCID: PMC8407486 DOI: 10.1093/jcag/gwab016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 12/19/2022] Open
Abstract
Background and Aims The effectiveness and safety of vaccinations can be altered by
immunosuppressive therapies, and perhaps by inflammatory bowel disease (IBD)
itself. These recommendations developed by the Canadian Association of
Gastroenterology and endorsed by the American Gastroenterological
Association, aim to provide guidance on immunizations in adult and pediatric
patients with IBD. This publication focused on inactivated vaccines. Methods Systematic reviews evaluating the efficacy, effectiveness, and safety of
vaccines in patients with IBD, other immune-mediated inflammatory diseases,
and the general population were performed. Critical outcomes included
mortality, vaccine-preventable diseases, and serious adverse events.
Immunogenicity was considered a surrogate outcome for vaccine efficacy.
Certainty of evidence and strength of recommendations were rated according
to the GRADE (Grading of Recommendation Assessment, Development, and
Evaluation) approach. Key questions were developed through an iterative
online platform, and voted on by a multidisciplinary group. Recommendations
were formulated using the Evidence-to-Decision framework. Strong
recommendation means that most patients should receive the recommended
course of action, whereas a conditional recommendation means that different
choices will be appropriate for different patients. Results Consensus was reached on 15 of 20 questions. Recommendations address the
following vaccines: Haemophilus influenzae type b,
recombinant zoster, hepatitis B, influenza, pneumococcus, meningococcus,
tetanus-diphtheria-pertussis, and human papillomavirus. Most of the
recommendations for patients with IBD are congruent with the current Centers
for Disease Control and Prevention and Canada’s National Advisory
Committee on Immunization recommendations for the general population, with
the following exceptions. In patients with IBD, the panel suggested
Haemophilus influenzae type b vaccine for patients
older than 5 years of age, recombinant zoster vaccine for adults younger
than 50 year of age, and hepatitis B vaccine for adults without a risk
factor. Consensus was not reached, and recommendations were not made for 5
statements, due largely to lack of evidence, including double-dose hepatitis
B vaccine, timing of influenza immunization in patients on biologics,
pneumococcal and meningococcal vaccines in adult patients without risk
factors, and human papillomavirus vaccine in patients aged 27–45
years. Conclusions Patients with IBD may be at increased risk of some vaccine-preventable
diseases. Therefore, maintaining appropriate vaccination status in these
patients is critical to optimize patient outcomes. In general, IBD is not a
contraindication to the use of inactivated vaccines, but immunosuppressive
therapy may reduce vaccine responses.
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Affiliation(s)
- Jennifer L Jones
- Department of Medicine and Community Health and Epidemiology, Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Frances Tse
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Matthew W Carroll
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer C deBruyn
- Section of Pediatric Gastroenterology, Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shelly A McNeil
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne Pham-Huy
- Division of Infectious Diseases, Immunology and Allergy, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Cynthia H Seow
- Division of Gastroenterology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lisa L Barrett
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicholas Carman
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Gil Y Melmed
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Otto G Vanderkooi
- Section of Infectious Diseases, Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - John K Marshall
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Eric I Benchimol
- Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada, SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology and Nutrition, The Hospital for Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, ICES, Toronto, Ontario, Canada.,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario and CHEO Research Institute, Ottawa, Ontario, Canada.,ICES Ottawa, Ottawa, Ontario, Canada
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10
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Benchimol EI, Tse F, Carroll MW, deBruyn JC, McNeil SA, Pham-Huy A, Seow CH, Barrett LL, Bessissow T, Carman N, Melmed GY, Vanderkooi OG, Marshall JK, Jones JL. Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)-Part 1: Live Vaccines. J Can Assoc Gastroenterol 2021; 4:e59-e71. [PMID: 34476338 PMCID: PMC8407487 DOI: 10.1093/jcag/gwab015] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background & Aims Patients with inflammatory bowel disease (IBD) may be at increased risk of
some vaccine-preventable diseases. The effectiveness and safety of
vaccinations may be altered by immunosuppressive therapies or IBD itself.
These recommendations, developed by the Canadian Association of
Gastroenterology and endorsed by the American Gastroenterological
Association, aim to provide guidance on immunizations in patients with
inflammatory bowel disease. This publication focused on live vaccines. Methods Systematic reviews evaluating the efficacy, effectiveness, and safety of
vaccines in patients with IBD, other immune-mediated inflammatory diseases,
and the general population were performed. Critical outcomes included
mortality, vaccine-preventable diseases, and serious adverse events.
Immunogenicity was considered a surrogate outcome for vaccine efficacy.
Certainty of evidence and strength of recommendations were rated according
to the GRADE (Grading of Recommendation Assessment, Development, and
Evaluation) approach. Key questions were developed through an iterative
process and voted on by a multidisciplinary panel. Recommendations were
formulated using the Evidence-to-Decision framework. Strong recommendation
means that most patients should receive the recommended course of action,
whereas a conditional recommendation means that different choices will be
appropriate for different patients. Results Three good practice statements included reviewing a patient’s
vaccination status at diagnosis and at regular intervals, giving appropriate
vaccinations as soon as possible, and not delaying urgently needed
immunosuppressive therapy to provide vaccinations. There are 4
recommendations on the use of live vaccines. Measles, mumps, rubella vaccine
is recommended for both adult and pediatric patients with IBD not on
immunosuppressive therapy, but not for those using immunosuppressive
medications (conditional). Varicella vaccine is recommended for pediatric
patients with IBD not on immunosuppressive therapy, but not for those using
immunosuppressive medications (conditional). For adults, recommendations are
conditionally in favor of varicella vaccine for those not on
immunosuppressive therapy, and against for those on therapy. No
recommendation was made regarding the use of live vaccines in infants born
to mothers using biologics because the desirable and undesirable effects
were closely balanced and the evidence was insufficient. Conclusions Maintaining appropriate vaccination status in patients with IBD is critical
to optimize patient outcomes. In general, live vaccines are recommended in
patients not on immunosuppressive therapy, but not for those using
immunosuppressive medications. Additional studies are needed to evaluate the
safety and efficacy of live vaccines in patients on immunosuppressive
therapy.
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Affiliation(s)
- Eric I Benchimol
- Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, and CHEO Research Institute, Ottawa, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada, SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology and Nutrition, The Hospital for Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, ICES, Toronto, Ontario, Canada
| | - Frances Tse
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Matthew W Carroll
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer C deBruyn
- Section of Pediatric Gastroenterology, Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shelly A McNeil
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne Pham-Huy
- Division of Infectious Diseases, Immunology and Allergy, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario
| | - Cynthia H Seow
- Division of Gastroenterology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lisa L Barrett
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicholas Carman
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Gil Y Melmed
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Otto G Vanderkooi
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California.,Section of Infectious Diseases, Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - John K Marshall
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer L Jones
- Department of Medicine and Community Health and Epidemiology, Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
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11
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Benchimol EI, Tse F, Carroll MW, deBruyn JC, McNeil SA, Pham-Huy A, Seow CH, Barrett LL, Bessissow T, Carman N, Melmed GY, Vanderkooi OG, Marshall JK, Jones JL. Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)-Part 1: Live Vaccines. Gastroenterology 2021; 161:669-680.e0. [PMID: 33617891 DOI: 10.1053/j.gastro.2020.12.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 09/16/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Patients with inflammatory bowel disease (IBD) may be at increased risk of some vaccine-preventable diseases. The effectiveness and safety of vaccinations may be altered by immunosuppressive therapies or IBD itself. These recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on immunizations in adult and pediatric patients with IBD. This publication focused on live vaccines. METHODS Systematic reviews evaluating the efficacy, effectiveness, and safety of vaccines in patients with IBD, other immune-mediated inflammatory diseases, and the general population were performed. Critical outcomes included mortality, vaccine-preventable diseases, and serious adverse events. Immunogenicity was considered a surrogate outcome for vaccine efficacy. Certainty of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. Key questions were developed through an iterative process and voted on by a multidisciplinary panel. Recommendations were formulated using the Evidence-to-Decision framework. Strong recommendation means that most patients should receive the recommended course of action, whereas a conditional recommendation means that different choices will be appropriate for different patients. RESULTS Three good practice statements included reviewing a patient's vaccination status at diagnosis and at regular intervals, giving appropriate vaccinations as soon as possible, and not delaying urgently needed immunosuppressive therapy to provide vaccinations. There are 4 recommendations on the use of live vaccines. Measles, mumps, rubella vaccine is recommended for both adult and pediatric patients with IBD not on immunosuppressive therapy, but not for those using immunosuppressive medications (conditional). Varicella vaccine is recommended for pediatric patients with IBD not on immunosuppressive therapy, but not for those using immunosuppressive medications (conditional). For adults, recommendations are conditionally in favor of varicella vaccine for those not on immunosuppressive therapy, and against for those on therapy. No recommendation was made regarding the use of live vaccines in infants born to mothers using biologics because the desirable and undesirable effects were closely balanced and the evidence was insufficient. CONCLUSIONS Maintaining appropriate vaccination status in patients with IBD is critical to optimize patient outcomes. In general, live vaccines are recommended in patients not on immunosuppressive therapy, but not for those using immunosuppressive medications. Additional studies are needed to evaluate the safety and efficacy of live vaccines in patients on immunosuppressive therapy.
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Affiliation(s)
- Eric I Benchimol
- Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada, CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, and CHEO Research Institute, Ottawa, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada, SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology and Nutrition, The Hospital for Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, ICES, Toronto, Ontario, Canada
| | - Frances Tse
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Matthew W Carroll
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer C deBruyn
- Section of Pediatric Gastroenterology, Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shelly A McNeil
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne Pham-Huy
- Division of Infectious Diseases, Immunology and Allergy, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario
| | - Cynthia H Seow
- Division of Gastroenterology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lisa L Barrett
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicholas Carman
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada, CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Gil Y Melmed
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Otto G Vanderkooi
- Section of Infectious Diseases, Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - John K Marshall
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer L Jones
- Department of Medicine and Community Health and Epidemiology, Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
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12
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Jones JL, Tse F, Carroll MW, deBruyn JC, McNeil SA, Pham-Huy A, Seow CH, Barrett LL, Bessissow T, Carman N, Melmed GY, Vanderkooi OG, Marshall JK, Benchimol EI. Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)-Part 2: Inactivated Vaccines. Gastroenterology 2021; 161:681-700. [PMID: 34334167 DOI: 10.1053/j.gastro.2021.04.034] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The effectiveness and safety of vaccinations can be altered by immunosuppressive therapies, and perhaps by inflammatory bowel disease (IBD) itself. These recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on immunizations in adult and pediatric patients with IBD. This publication focused on inactivated vaccines. METHODS Systematic reviews evaluating the efficacy, effectiveness, and safety of vaccines in patients with IBD, other immune-mediated inflammatory diseases, and the general population were performed. Critical outcomes included mortality, vaccine-preventable diseases, and serious adverse events. Immunogenicity was considered a surrogate outcome for vaccine efficacy. Certainty of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. Key questions were developed through an iterative online platform, and voted on by a multidisciplinary group. Recommendations were formulated using the Evidence-to-Decision framework. Strong recommendation means that most patients should receive the recommended course of action, whereas a conditional recommendation means that different choices will be appropriate for different patients. RESULTS Consensus was reached on 15 of 20 questions. Recommendations address the following vaccines: Haemophilus influenzae type b, recombinant zoster, hepatitis B, influenza, pneumococcus, meningococcus, tetanus-diphtheria-pertussis, and human papillomavirus. Most of the recommendations for patients with IBD are congruent with the current Centers for Disease Control and Prevention and Canada's National Advisory Committee on Immunization recommendations for the general population, with the following exceptions. In patients with IBD, the panel suggested Haemophilus influenzae type b vaccine for patients older than 5 years of age, recombinant zoster vaccine for adults younger than 50 year of age, and hepatitis B vaccine for adults without a risk factor. Consensus was not reached, and recommendations were not made for 5 statements, due largely to lack of evidence, including double-dose hepatitis B vaccine, timing of influenza immunization in patients on biologics, pneumococcal and meningococcal vaccines in adult patients without risk factors, and human papillomavirus vaccine in patients aged 27-45 years. CONCLUSIONS Patients with IBD may be at increased risk of some vaccine-preventable diseases. Therefore, maintaining appropriate vaccination status in these patients is critical to optimize patient outcomes. In general, IBD is not a contraindication to the use of inactivated vaccines, but immunosuppressive therapy may reduce vaccine responses.
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Affiliation(s)
- Jennifer L Jones
- Department of Medicine and Community Health and Epidemiology, Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
| | - Frances Tse
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Matthew W Carroll
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer C deBruyn
- Section of Pediatric Gastroenterology, Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shelly A McNeil
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne Pham-Huy
- Division of Infectious Diseases, Immunology and Allergy, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Cynthia H Seow
- Division of Gastroenterology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lisa L Barrett
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicholas Carman
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada, CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Gil Y Melmed
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Otto G Vanderkooi
- Section of Infectious Diseases, Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - John K Marshall
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Eric I Benchimol
- Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada, CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario and CHEO Research Institute, Ottawa, Ontario, Canada, ICES Ottawa, Ottawa, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada, SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology and Nutrition, The Hospital for Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, ICES, Toronto, Ontario, Canada.
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Kellner JD, Ricketson LJ, Demczuk WHB, Martin I, Tyrrell GJ, Vanderkooi OG, Mulvey MR. Whole-Genome Analysis of Streptococcus pneumoniae Serotype 4 Causing Outbreak of Invasive Pneumococcal Disease, Alberta, Canada. Emerg Infect Dis 2021; 27:1867-1875. [PMID: 34152965 PMCID: PMC8237880 DOI: 10.3201/eid2707.204403] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/13/2022] Open
Abstract
After the introduction of pneumococcal conjugate vaccines for children, invasive pneumococcal disease caused by Streptococcus pneumoniae serotype 4 declined in all ages in Alberta, Canada, but it has reemerged and spread in adults in Calgary, primarily among persons who are experiencing homelessness or who use illicit drugs. We conducted clinical and molecular analyses to examine the cases and isolates. Whole-genome sequencing analysis indicated relatively high genetic variability of serotype 4 isolates. Phylogenetic analysis identified 1 emergent sequence type (ST) 244 lineage primarily associated within Alberta and nationally distributed clades ST205 and ST695. Isolates from 6 subclades of the ST244 lineage clustered regionally, temporally, and by homeless status. In multivariable logistic regression, factors associated with serotype 4 invasive pneumococcal disease were being male, being <65 years of age, experiencing homelessness, having a diagnosis of pneumonia or empyema, or using illicit drugs.
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14
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Freedman SB, Xie J, Lee BE, Ali S, Pang XL, Chui L, Zhuo R, Vanderkooi OG, Tellier R, Funk AL, Tarr PI. Microbial Etiologies and Clinical Characteristics of Children Seeking Emergency Department Care Due to Vomiting in the Absence of Diarrhea. Clin Infect Dis 2021; 73:1414-1423. [PMID: 33993272 PMCID: PMC9794187 DOI: 10.1093/cid/ciab451] [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: 03/05/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND As children with isolated vomiting are rarely able to provide a specimen suitable for routine pathogen testing, we have limited knowledge about their infecting pathogens. METHODS Between December 2014 and August 2018, children <18 years old with presumed acute gastroenteritis who presented to 2 emergency departments (EDs) in Alberta, Canada, were recruited. Eligible participants had ≥3 episodes of vomiting and/or diarrhea in a 24-hour period, <7 days of symptoms, and provided a rectal swab or stool specimen. We quantified the proportion of children with isolated vomiting in whom an enteropathogen was identified, and analyzed clinical characteristics, types of enteropathogens, resources used, and alternative diagnoses. RESULTS Of the 2695 participants, at the ED visit, 295 (10.9%), 1321 (49.0%), and 1079 (40.0%) reported having isolated diarrhea, vomiting and diarrhea, or isolated vomiting, respectively. An enteropathogen was detected most commonly in those with vomiting and diarrhea (1067/1321; 80.8%); detection did not differ between those with isolated diarrhea (170/295; 57.6%) and isolated vomiting (589/1079; 54.6%) (95% confidence interval of the difference: -3.4%, 9.3%). Children with isolated vomiting most often had a virus (557/1077; 51.7%), most commonly norovirus (321/1077; 29.8%); 5.7% (62/1079) had a bacterial pathogen. X-rays, ultrasounds, and urine tests were most commonly performed in children with isolated vomiting. Alternate etiologies were most common in those with isolated vomiting (5.7%; 61/1079). CONCLUSIONS The rate of enteropathogen identification in children with isolated vomiting using molecular diagnostic tests and rectal swabs is substantial. Molecular diagnostics offer an emerging diagnostic strategy in children with isolated vomiting.
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Affiliation(s)
- Stephen B Freedman
- Division of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics and Emergency Medicine, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Correspondence: S. B. Freedman, Professor of Pediatrics and Emergency Medicine, Alberta Children’s Hospital Foundation Professor in Child Health and Wellness, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB Canada T3B 6A8 ()
| | - Jianling Xie
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Xiao-Li Pang
- Department of Laboratory of Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - Linda Chui
- Department of Laboratory of Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - Ran Zhuo
- Department of Laboratory of Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Otto G Vanderkooi
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Microbiology, Immunology, and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences. Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta,Canada
| | - Raymond Tellier
- Department of Medicine, McGill University and Optilab Montreal, McGill University Health Centre, Montreal, Quebec, Canada
| | - Anna L Funk
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Phillip I Tarr
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Bhavanam S, Freedman SB, Lee BE, Zhuo R, Qiu Y, Chui L, Xie J, Ali S, Vanderkooi OG, Pang XL. Differences in Illness Severity among Circulating Norovirus Genotypes in a Large Pediatric Cohort with Acute Gastroenteritis. Microorganisms 2020; 8:E1873. [PMID: 33256234 PMCID: PMC7760397 DOI: 10.3390/microorganisms8121873] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Norovirus is a major pathogen identified in children with acute gastroenteritis (AGE), little is known about the strain's diversity and their clinical severity. Stool and/or rectal swabs were collected from children ≤18 years of age recruited at emergency departments (ED), and a provincial nursing advice phone line due to AGE symptoms in the province of Alberta, Canada between December 2014 and August 2018. Specimens were tested using a reverse transcription real time PCR and genotyped by Sanger sequencing. The Modified Vesikari Scale score (MVS) was used to evaluate the disease severity. The objectives are to identify the Genogroup and Genotype distribution and to compare illness severity between the GI and GII genogroups and to complete further analyses comparing the GII genotypes identified. GII.4 was the genotype most commonly identified. Children with GII.4 had higher MVS scores (12.0 (10.0, 14.0; p = 0.002)) and more prolonged diarrheal (5 days (3.0, 7.8)) and vomiting (3.2 days (1.7, 5.3; p < 0.001)) durations compared to other non GII.4 strains. The predominant strain varied by year with GII.4 Sydney[P31] predominant in 2014/15, GII.4 Sydney[P16] in 2015/16 and 2017/18, and GII.3[P12] in 2016/17. Genogroup II norovirus strains predominated in children with AGE with variance between years; clinical severity associated with different strains varied with episodes being most severe among GII.4 infected children.
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Affiliation(s)
- Sudha Bhavanam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (S.B.); (R.Z.); (Y.Q.); (L.C.)
| | - Stephen B. Freedman
- Divisions of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada;
| | - Bonita E. Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children’s Health Research Institute, Stollery Children’s Hospital, University of Alberta, Edmonton, AB T6G 2R3, Canada; (B.E.L.); (S.A.)
| | - Ran Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (S.B.); (R.Z.); (Y.Q.); (L.C.)
| | - Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (S.B.); (R.Z.); (Y.Q.); (L.C.)
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (S.B.); (R.Z.); (Y.Q.); (L.C.)
- Public Health Laboratories (ProvLab), Alberta Precision Laboratories (APL), Edmonton, AB T6G 2J2, Canada
| | - Jianling Xie
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada;
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children’s Health Research Institute, Stollery Children’s Hospital, University of Alberta, Edmonton, AB T6G 2R3, Canada; (B.E.L.); (S.A.)
| | - Otto G. Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada;
| | - Xiaoli L. Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (S.B.); (R.Z.); (Y.Q.); (L.C.)
- Public Health Laboratories (ProvLab), Alberta Precision Laboratories (APL), Edmonton, AB T6G 2J2, Canada
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16
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Martinón-Torres F, Halperin SA, Nolan T, Tapiero B, Perrett KP, de la Cueva IS, García-Sicilia J, Stranak Z, Vanderkooi OG, Kosina P, Virta M, Merino Arribas JM, Miranda-Valdivieso M, Arias Novas B, Bozensky J, Cilleruelo Ortega M, Ramos Amador JT, Baca M, Escribano PE, Zuccotti GV, Janota J, Marchisio PG, Kostanyan L, Meyer N, Ceregido MA, Cheuvart B, Kuriyakose SO, Mesaros N. Immunantwort auf die DTPa-HBV-IPV/Hib-Auffrischimpfung bei Kleinkindern von Müttern, die während der Schwangerschaft mit Tdap-Impfstoff geimpft worden waren: Folgestudie einer randomisierten, placebokontrollierten Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717189] [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: 10/23/2022] Open
Affiliation(s)
- F Martinón-Torres
- Hospital Clínico Universitario de Santiago, Pediatría Clínica, Infectológica y Traslacional
| | - SA Halperin
- Dalhousie University, Canadian Center for Vaccinology
| | - T Nolan
- University of Melbourne, Murdoch Children’s Research Institute and Melbourne School of Population and Global Health
| | - B Tapiero
- Université de Montréal, CHU Sainte Justine
| | - KP Perrett
- University of Melbourne, Murdoch Children’s Research Institute and Melbourne School of Population and Global Health
| | - IS de la Cueva
- Instituto Hispalense de Pediatría, Unidad de Investigación
| | - J García-Sicilia
- Hospital Universitario Madrid Sanchinarro, Servicio de Pediatría
| | - Z Stranak
- Institute for the Care of Mother and Child, Neonatology Department
| | - OG Vanderkooi
- Alberta Children’s Hospital, University of Calgary, Departments of Pediatrics, Microbiology, Immunology and Infectious DiseasesPathology and Laboratory Medicine and Community Health Sciences, Pathology and Laboratory Medicine and Community Health Sciences, Alberta Children’s Hospital Research Institut
| | - P Kosina
- University Hospital, Department of Infectious Diseases
| | - M Virta
- Tampere University, Tampere Vaccine Research Center
| | | | | | - B Arias Novas
- Hospital Universitario Sanitas La Zarzuela, Servicio de Pediatría
| | - J Bozensky
- Vitkovice Hospital, Pediatrics Department
| | | | | | - M Baca
- Hospital Quiron Malaga, Departamento de Pediatría y Neonatología
| | | | - GV Zuccotti
- University of Milan, Ospedale dei Bambini Vittore Buzzi
| | - J Janota
- Thomayer Hospital Prague, Department of Neonatology
| | - PG Marchisio
- University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico
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17
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Xie J, Pang XL, Tarr GAM, Mu Y, Zhuo R, Chui L, Lee BE, Vanderkooi OG, Tarr PI, Ali S, MacDonald SE, Freedman SB. Influenza virus detection in the stool of children with acute gastroenteritis. J Clin Virol 2020; 131:104565. [PMID: 32810839 DOI: 10.1016/j.jcv.2020.104565] [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: 01/07/2020] [Revised: 07/18/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine if the clinical characteristics of children with gastroenteritis and influenza identified in their stool differ from those whose stool was influenza-negative. METHODS Children <18-years with gastroenteritis whose stool tested negative for enteropathogen were tested for influenza in stool. The clinical features between influenza-positive and influenza-negative gastroenteritis cases were compared. Stools from controls without infection were also tested for influenza. RESULTS Among the 440 gastroenteritis cases, those who were influenza test-positive were older [median age 4.0 (IQR: 2.3, 5.5) vs. 1.5 (IQR: 0.5, 4.0) years; P = 0.008], more likely to present in fall or winter (92.3 % vs. 48.0 %; P = 0.001), be febrile (84.6 % vs. 30.6 %; P < 0.001), have respiratory symptoms (91.7 % vs. 44.8 %; P = 0.002), have dehydration [median Clinical Dehydration Scale score: 4 (IQR: 1.5, 4.5) vs. 2 (IQR: 0, 3); P = 0.034], and have higher Modified Vesikari Scale scores [median: 13 (IQR: 10.5, 14.0) vs. 10 (IQR: 9.0, 13.0); P = 0.044], than those who tested negative. Thirteen gastroenteritis cases (13/440; 3.0 %) including one child without respiratory symptoms vs. one control (1/250; 0.4 %) were influenza stool positive. CONCLUSIONS Fever, respiratory symptoms, more severe illness, and older age were more common in children with gastroenteritis with influenza detected in stool, compared to those tested negative.
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Affiliation(s)
- Jianling Xie
- Section of Pediatric Emergency Medicine, Department of Pediatric, Alberta Children Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Xiao-Li Pang
- Alberta Precision Laboratories-Provincial Laboratory for Public Health, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Gillian A M Tarr
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yuan Mu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Laboratory, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ran Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Linda Chui
- Alberta Precision Laboratories-Provincial Laboratory for Public Health, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada
| | - Otto G Vanderkooi
- Department of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences and the Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Phillip I Tarr
- Department of Pediatrics, Division of Gastroenterology, Hepatology & Nutrition, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada
| | - Shannon E MacDonald
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Stephen B Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Section of Pediatric Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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18
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Tarr GAM, Pang XL, Zhuo R, Lee BE, Chui L, Ali S, Vanderkooi OG, Michaels-Igbokwe C, Tarr PI, MacDonald SE, Currie G, MacDonald J, Kim K, Freedman SB. Attribution of Pediatric Acute Gastroenteritis Episodes and Emergency Department Visits to Norovirus Genogroups I and II. J Infect Dis 2020; 223:452-461. [PMID: 32614406 DOI: 10.1093/infdis/jiaa391] [Citation(s) in RCA: 3] [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] [Received: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Norovirus is a leading cause of acute gastroenteritis. With vaccines in development, population-based estimates of norovirus burden are needed to identify target populations, quantify potential benefits, and understand disease dynamics. METHODS We estimated the attributable fraction (AF) for norovirus infections in children, defined as the proportion of children testing positive for norovirus whose gastroenteritis was attributable to norovirus. We calculated the standardized incidence and emergency department (ED) visit rates attributable to norovirus using provincial gastroenteritis visit administrative data. RESULTS From 3731 gastroenteritis case patients and 2135 controls we determined that the AFs were 67.0% (95% confidence interval [CI], 31.5%-100%) and 91.6% (88.8%-94.4%) for norovirus genogroups I (GI) and II (GII), respectively. Norovirus GII AF varied by season but not age. We attributed 116 episodes (95% CI, 103-129) and 59 (51-67) ED visits per 10 000 child-years to norovirus GII across all ages, accounting for 20% and 18% of all medically attended gastroenteritis episodes and ED visits, respectively. CONCLUSIONS In children, a large proportion of norovirus GII detections reflect causation, demonstrating significant potential for norovirus GII vaccines. Seasonal variation in the norovirus GII AF may have implications for understanding the role asymptomatic carriage plays in disease dynamics.
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Affiliation(s)
- Gillian A M Tarr
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Precision Laboratories-ProvLab, Edmonton, Alberta, Canada
| | - Ran Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Precision Laboratories-ProvLab, Edmonton, Alberta, Canada
| | - Samina Ali
- Departments of Pediatrics and Emergency Medicine, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Otto G Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine, and Community Health Sciences, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christine Michaels-Igbokwe
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, & Nutrition, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Gillian Currie
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Judy MacDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Bettinger JA, De Serres G, Valiquette L, Vanderkooi OG, Kellner JD, Coleman BL, Top KA, Isenor JE, McCarthy AE. 2017/18 and 2018/19 seasonal influenza vaccine safety surveillance, Canadian National Vaccine Safety (CANVAS) Network. ACTA ACUST UNITED AC 2020; 25. [PMID: 32524947 PMCID: PMC7336108 DOI: 10.2807/1560-7917.es.2020.25.22.1900470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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 a health problem of sufficient intensity to prevent their normal daily activities and/or cause them to seek medical care (including hospitalisation). This compared to 323 of 13,578 (2.4%; 95% CI: 2.1–2.6) and 544 of 21,999 (2.5%; 95% CI: 2.3–2.7) controls in each respective season. The event rate in vaccinated adults and children was higher than the background rate and was associated with specific influenza vaccines. The higher rate of events was associated with systemic symptoms and migraines/headaches. Conclusion In 2017/18 and 2018/19, higher rates of events were reported following seasonal influenza vaccination than in the pre-vaccination period. This signal was associated with several seasonal influenza vaccine products.
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Affiliation(s)
- Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | | | - Louis Valiquette
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Otto G Vanderkooi
- Department of Pediatrics and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - James D Kellner
- Department of Pediatrics and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | | | - Karina A Top
- Canadian Center for Vaccinology, IWK Health Centre and Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Jennifer E Isenor
- College of Pharmacy and Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
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- The Canadian Immunization Research Network is acknowledged at the end of this article
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20
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Abu-Raya B, Bettinger JA, Vanderkooi OG, Vaudry W, Halperin SA, Sadarangani M. Burden of Children Hospitalized With Pertussis in Canada in the Acellular Pertussis Vaccine Era, 1999-2015. J Pediatric Infect Dis Soc 2020; 9:118-127. [PMID: 30535079 PMCID: PMC7192396 DOI: 10.1093/jpids/piy128] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recent increases in pertussis morbidity and mortality rates among young infants have led to a recommendation in some countries for vaccination against pertussis during pregnancy. Having data on the burden of pediatric pertussis in a large population over time is important for establishing the true burden of disease in the acellular pertussis (aP) vaccine era. Here, we describe age-specific epidemiology and morbidity and mortality rates in children hospitalized with pertussis over 17 years across Canada in the aP vaccine era. METHODS Patients aged ≤16 years who were admitted to 1 of 12 pediatric tertiary-care hospitals across Canada between 1999 and 2015 with confirmed (laboratory-confirmed or epidemiologically linked) or probable (clinically diagnosed) pertussis were included. RESULTS Overall, 1402 patients with pertussis were included. Infants aged <2 months had the highest mean annual incidences of pertussis hospitalization and intensive care unit (ICU) admission (116.40 [95% confidence interval (CI), 85.32-147.49] and 33.48 [95% CI, 26.35-40.62] per 100 000 population, respectively). The overall proportion of children who required ICU admission was 25.46%, and the proportion was highest in infants aged <2 months (37.90%). Over the span of this study, 21 deaths occurred. Age of <16 weeks, prematurity, encephalopathy, and a confirmed pertussis diagnosis were independent risk factors for ICU admission. Age of <4 weeks, prematurity, and female sex were independent risk factors for death. CONCLUSIONS In the aP vaccine era, endemic pertussis still contributes considerably to childhood morbidity and death, particularly in infants aged <2 months. Vaccination against pertussis during pregnancy has the potential to reduce this disease burden.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Otto G Vanderkooi
- Departments of Paediatrics, Microbiology, Immunology and Infectious Diseases, Pathology, and Laboratory Medicine, University of Calgary, Canada
- Alberta Children’s Hospital Research Institute, Alberta Health Services, Canada
| | - Wendy Vaudry
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Stollery Children’s Hospital, Edmonton, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax, Canada
- Department of Pediatrics, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax, Canada
- Department of Microbiology and Immunology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
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21
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Perrett KP, Halperin SA, Nolan T, Carmona Martínez A, Martinón-Torres F, García-Sicilia J, Virta M, Vanderkooi OG, Zuccotti GV, Manzoni P, Kostanyan L, Meyer N, Ceregido MA, Cheuvart B, Kuriyakose SO, Stranak Z, Merino Arribas JM, Cilleruelo Ortega MJ, Miranda-Valdivieso M, Arias Novas B, Ramos Amador JT, Omeñaca F, Baca M, Marchisio PG, Mesaros N. Impact of tetanus-diphtheria-acellular pertussis immunization during pregnancy on subsequent infant immunization seroresponses: follow-up from a large randomized placebo-controlled trial. Vaccine 2019; 38:2105-2114. [PMID: 31776027 DOI: 10.1016/j.vaccine.2019.10.104] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 08/07/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pertussis immunization during pregnancy results in high pertussis antibody concentrations in young infants but may interfere with infant immune responses to post-natal immunization. METHODS This phase IV, multi-country, open-label study assessed the immunogenicity and safety of infant primary vaccination with DTaP-HepB-IPV/Hib and 13-valent pneumococcal conjugate vaccine (PCV13). Enrolled infants (6-14 weeks old) were born to mothers who were randomized to receive reduced-antigen-content diphtheria-tetanus-three-component acellular pertussis vaccine (Tdap group) or placebo (control group) during pregnancy (270/7-366/7 weeks' gestation) with crossover immunization postpartum. All infants received 2 or 3 DTaP-HepB-IPV/Hib and PCV13 doses according to national schedules. Immunogenicity was assessed in infants pre- and 1 month post-primary vaccination. The primary objective was to assess seroprotection/vaccine response rates for DTaP-HepB-IPV/Hib antigens 1 month post-primary vaccination. RESULTS 601 infants (Tdap group: 296; control group: 305) were vaccinated. One month post-priming, seroprotection rates were 100% (diphtheria; tetanus), ≥98.5% (hepatitis B), ≥95.9% (polio) and ≥94.5% (Hib) in both groups. Vaccine response rates for pertussis antigens were significantly lower in infants whose mothers received pregnancy Tdap (37.5-77.1%) versus placebo (90.0-99.2%). Solicited and unsolicited adverse event rates were similar between groups. Serious adverse events occurred in 2.4% (Tdap group) and 5.6% (control group) of infants, none were vaccination-related. CONCLUSIONS Pertussis antibodies transferred during pregnancy may decrease the risk of pertussis infection in the first months of life but interfere with the infant's ability to produce pertussis antibodies, the clinical significance of which remains unknown. Safety and reactogenicity results were consistent with previous experience. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT02422264.
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Affiliation(s)
- Kirsten P Perrett
- Murdoch Children's Research Institute and Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Scott A Halperin
- Dalhousie University, Canadian Center for Vaccinology, Halifax, Canada.
| | - Terry Nolan
- Murdoch Children's Research Institute and Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | | | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela and Genetics, Vaccines and Pediatrics Research Group, University of Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain.
| | | | - Miia Virta
- Tampere Vaccine Research Center, Tampere University, Tampere, Finland.
| | - Otto G Vanderkooi
- Alberta Children's Hospital, University of Calgary, Alberta, Calgary, Canada.
| | | | - Paolo Manzoni
- Ospedale Ostetrico Ginecologico Sant'Anna, Turin, Italy and Department of Maternal-Infant -Pediatric Health, Hospital "Degli Infermi", Biella, Italy
| | | | | | | | | | | | - Zbynek Stranak
- Institute for the Care of Mother and Child, Prague, Czech Republic.
| | | | | | | | | | | | | | - Manuel Baca
- Hospital Quiron Malaga, Andalucia, Malaga, Spain.
| | - Paola Giovanna Marchisio
- Unità Pediatrica di Cure Altamente Intensive, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Lombardia, Milano, Italy.
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22
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Halperin SA, Langley JM, Ye L, MacKinnon-Cameron D, Elsherif M, Allen VM, Smith B, Halperin BA, McNeil SA, Vanderkooi OG, Dwinnell S, Wilson RD, Tapiero B, Boucher M, Le Saux N, Gruslin A, Vaudry W, Chandra S, Dobson S, Money D. A Randomized Controlled Trial of the Safety and Immunogenicity of Tetanus, Diphtheria, and Acellular Pertussis Vaccine Immunization During Pregnancy and Subsequent Infant Immune Response. Clin Infect Dis 2019; 67:1063-1071. [PMID: 30010773 DOI: 10.1093/cid/ciy244] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background Immunization of pregnant women with tetanus-diphtheria-acellular pertussis vaccine (Tdap) provides protection against pertussis to the newborn infant. Methods In a randomized, controlled, observer-blind, multicenter clinical trial, we measured the safety and immunogenicity of Tdap during pregnancy and the effect on the infant's immune response to primary vaccination at 2, 4, and 6 months and booster vaccination at 12 months of age. A total of 273 women received either Tdap or tetanus-diphtheria (Td) vaccine in the third trimester and provided information for the safety analysis and samples for the immunogenicity analyses; 261 infants provided serum for the immunogenicity analyses. Results Rates of adverse events were similar in both groups. Infants of Tdap recipients had cord blood levels that were 21% higher than maternal levels for pertussis toxoid (PT), 13% higher for filamentous hemagglutinin (FHA), 4% higher for pertactin (PRN), and 7% higher for fimbriae (FIM). These infants had significantly higher PT antibody levels at birth and at 2 months and significantly higher FHA, PRN, and FIM antibodies at birth and 2 and 4 months, but significantly lower PT and FHA antibody levels at 6 and 7 months and significantly lower PRN and FIM antibody levels at 7 months than infants whose mothers received Td. Differences persisted prebooster at 12 months for all antigens and postbooster 1 month later for PT, FHA, and FIM. Conclusions This study demonstrated that Tdap during pregnancy results in higher levels of antibodies early in infancy but lower levels after the primary vaccine series. Clinical Trials Registration NCT00553228.
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Affiliation(s)
- Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Pediatrics, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Microbiology and Immunology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Joanne M Langley
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Pediatrics, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Community Health and Epidemiology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Lingyun Ye
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - May Elsherif
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Victoria M Allen
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Community Health and Epidemiology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Obstetrics and Gynaecology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Bruce Smith
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Mathematics and Statistics, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Beth A Halperin
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Pediatrics, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,School of Nursing, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Shelly A McNeil
- Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Pediatrics, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax.,Department of Medicine, Dalhousie University and the IWK Health Centre and Nova Scotia Health Authority, Halifax
| | - Otto G Vanderkooi
- Departments of Paediatrics, Microbiology, Immunology and Infectious Diseases, Pathology, and Laboratory Medicine.,Alberta Children's Hospital Research Institute, Alberta Health Services
| | | | - R Douglas Wilson
- Alberta Children's Hospital Research Institute, Alberta Health Services.,Department of Obstetrics and Gynaecology, University of Calgary.,Department of Medical Genetics, Cumming School of Medicine, University of Calgary
| | - Bruce Tapiero
- Centre Hospitalier Universitaire Sainte-Justine and University of Montreal
| | - Marc Boucher
- Centre Hospitalier Universitaire Sainte-Justine and University of Montreal
| | | | - Andrée Gruslin
- Department of Obstetrics and Gynaecology, University of Ottawa
| | - Wendy Vaudry
- Department of Pediatrics, University of Alberta and the Women and Children's Health Research Institute, Edmonton
| | - Sue Chandra
- Department of Obstetrics and Gynecology, University of Alberta and the Women and Children's Health Research Institute, Edmonton
| | - Simon Dobson
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Deborah Money
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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23
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Tarr GAM, Chui L, Lee BE, Pang XL, Ali S, Nettel-Aguirre A, Vanderkooi OG, Berenger BM, Dickinson J, Tarr PI, Drews S, MacDonald J, Kim K, Freedman SB. Performance of Stool-testing Recommendations for Acute Gastroenteritis When Used to Identify Children With 9 Potential Bacterial Enteropathogens. Clin Infect Dis 2019; 69:1173-1182. [PMID: 30517612 PMCID: PMC7348586 DOI: 10.1093/cid/ciy1021] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/29/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The ability to identify bacterial pathogens that necessitate specific clinical management or public health action in children with acute gastroenteritis is crucial to patient care and public health. However, existing stool-testing guidelines offer inconsistent recommendations, and their performance characteristics are unknown. We evaluated 6 leading gastroenteritis guidelines (eg, those of the Centers for Disease Control and Prevention and Infectious Disease Society of America) that recommend when to test children's stool for bacterial enteropathogens. METHODS Via 2 emergency departments in Alberta, Canada, we enrolled 2447 children <18 years old who presented with ≥3 episodes of diarrhea and/or vomiting in a 24-hour period. All participants were tested for 9 bacterial enteropathogens: Aeromonas, Campylobacter, Escherichia coli O157, other Shiga toxin-producing E. coli, enterotoxigenic E. coli, Salmonella, Shigella, Vibrio, and Yersinia. Patient data gathered at the index visit were used to determine whether guidelines would recommend testing. Sensitivity and specificity to recommend testing for children with bacterial enteropathogens were calculated for each guideline. RESULTS Outcome data were available for 2391 (97.7%) participants, and 6% (144/2391) of participants tested positive for a bacterial enteropathogen. Guideline sensitivity ranged from 25.8% (95% confidence interval [CI] 18.7-33.0%) to 66.9% (95% CI 59.3-74.6%), and varied for individual pathogens. Guideline specificity for all bacterial enteropathogens ranged from 63.6% (95% CI 61.6-65.6%) to 96.5% (95% CI 95.7-97.2%). CONCLUSIONS No guideline provided optimally balanced performance. The most sensitive guidelines missed one-third of cases and would drastically increase testing volumes. The most specific guidelines missed almost 75% of cases.
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Affiliation(s)
- Gillian A M Tarr
- Department of Pediatrics, University of Calgary, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Women and Children’s Health Research Institute, University of Alberta, Alberta, Canada
| | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, Women and Children’s Health Research Institute, University of Alberta, Alberta, Canada
- Department of Emergency Medicine, Women and Children’s Health Research Institute, University of Alberta, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Alberta, Canada
| | - Otto G Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine, and Community Health Sciences, Alberta Children’s Hospital Research Institute, Alberta, Canada
| | - Byron M Berenger
- Department of Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada
- Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - James Dickinson
- Department of Family Medicine, University of Calgary, Alberta, Canada
| | - Phillip I Tarr
- Department of Pediatrics, Washington University in St. Louis School of Medicine, Missouri
| | - Steven Drews
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Judy MacDonald
- Alberta Health Services and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, University of Calgary, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
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24
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deBruyn JCC, Soon IS, Fonseca K, Feng S, Purtzki M, Goedhart C, Kuhn S, Vanderkooi OG, Wrobel I. Serologic Status of Routine Childhood Vaccines, Cytomegalovirus, and Epstein-Barr Virus in Children With Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1218-1226. [PMID: 30551205 DOI: 10.1093/ibd/izy366] [Citation(s) in RCA: 13] [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: 07/20/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on the serologic status of childhood vaccines, cytomegalovirus (CMV) and Epstein-Barr virus (EBV), are limited in inflammatory bowel disease (IBD). Therefore, we evaluated vaccine coverage and seroprotection, along with CMV and EBV seropositivity, in pediatric IBD. METHODS In a cross-sectional study, demographic data, IBD history, vaccine records, and serum for antibodies against measles, mumps, rubella, diphtheria, tetanus, varicella, hepatitis B (HBV), CMV, and EBV were collected from children with IBD. We evaluated potential factors associated with serologic status. RESULTS Of 156 subjects, vaccine coverage was up to date for age in 93.5% for measles, mumps, rubella, 95.6% for diphtheria, tetanus, pertussis, polio, hemophilus influenza B, 75.8% for HBV, and 93.5% for varicella, including past infection and vaccination. Seroprotection was present in 65.8% for measles, 60.5% for mumps, 79.1% for rubella, 79.5% for diphtheria, 80.8% for tetanus, 70.5% for varicella, and 62.8% for HBV of subjects. Older age at diagnosis was associated with seroprotection among subjects with complete HBV (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.03-1.39) and rubella series (OR, 1.18; 95% CI, 1.02-1.37). Older age at serum collection was associated with seroprotection among subjects with prior varicella vaccination or infection (OR, 1.69; 95% CI, 1.33-2.15). Only 25.2% and 37.8% demonstrated seropositivity to CMV and EBV, respectively. Among subjects on immunosuppressive medications, 75.3% and 62.4% were seronegative for CMV and EBV, respectively. CONCLUSIONS Children with IBD have low serologic protection to childhood vaccines in spite of high vaccine coverage and universal vaccinations. Children with IBD, including a large proportion on immunosuppressive medications, have low seropositivity to CMV and EBV.
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Affiliation(s)
- Jennifer C C deBruyn
- Section of Paediatric Gastroenterology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ing Shian Soon
- Section of Paediatric Gastroenterology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Fonseca
- Virology, Provincial Laboratory for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sharon Feng
- Section of Paediatric Gastroenterology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Purtzki
- Section of Paediatric Gastroenterology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Caitlin Goedhart
- Section of Paediatric Gastroenterology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Susan Kuhn
- Section of Infectious Diseases, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Otto G Vanderkooi
- Section of Infectious Diseases, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Iwona Wrobel
- Section of Paediatric Gastroenterology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
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25
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Dunbar M, Shah H, Shinde S, Vayalumkal J, Vanderkooi OG, Wei XC, Kirton A. Stroke in Pediatric Bacterial Meningitis: Population-Based Epidemiology. Pediatr Neurol 2018; 89:11-18. [PMID: 30392967 DOI: 10.1016/j.pediatrneurol.2018.09.005] [Citation(s) in RCA: 21] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/05/2018] [Accepted: 09/13/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bacterial meningitis is a severe infection of the nervous system with a high complication rate including stroke. The purpose of this study is to assess the incidence, risk factors, patterns, and outcomes in pediatric meningitis complicated by stroke. METHODS The study design was a population-based, 10-year retrospective (2002 to 2012) cohort study set in Southern Alberta, Canada. The inclusion criteria were: (1) age from newborn to 18 years, (2) brain magnetic resonance imaging (MRI) including diffusion-weighted imaging during admission, and (3) laboratory confirmed acute bacterial meningitis. The main outcomes were demographics, clinical presentations, risk factors, laboratory findings, radiographic findings, and neurological outcomes. FINDINGS Forty-three patients had confirmed bacterial meningitis and diffusion MRI (9 neonates (21%), 89% male; 22 infants aged one month to one year (51%), 50% male; and 12 children older than one year (28%), 58% male, median age four years (interquartile range 7.9 years). Ischemic stroke was confirmed in 16/43 (37%), often multifocal (94%). Patients with stroke were significantly more likely to have seizures (P = 0.025), otitis media (P = 0.029), and multiple presentations to hospital (P = 0.013). Mortality was 25% in children with stroke compared with 4% in those without (P = 0.067). Survivors with stroke were more likely to have neurological deficits at follow-up (69% versus 26%, P = 0.019). CONCLUSIONS More than one-third of children with acute bacterial meningitis and clinically indicated MRI had ischemic stroke. Stroke was associated with clinical factors including duration of illness, seizures, and causative organisms. Stroke was associated with higher mortality and morbidity, warranting consideration of increased MRI screening and new approaches to treatment.
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Affiliation(s)
- Mary Dunbar
- Department of Community Health Services, University of Calgary, Calgary, Alberta, Canada; Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada
| | - Hely Shah
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Siddharth Shinde
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Joseph Vayalumkal
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Otto G Vanderkooi
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Xing-Chang Wei
- Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Services, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada; Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.
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26
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Xie J, Nettel-Aguirre A, Lee BE, Chui L, Pang XL, Zhuo R, Parsons B, Vanderkooi OG, Tarr PI, Ali S, Dickinson JA, Hagen E, Svenson LW, MacDonald SE, Drews SJ, Tellier R, Graham T, Lavoie M, MacDonald J, Freedman SB. Relationship between enteric pathogens and acute gastroenteritis disease severity: a prospective cohort study. Clin Microbiol Infect 2018; 25:454-461. [PMID: 29964235 DOI: 10.1016/j.cmi.2018.06.016] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/28/2018] [Accepted: 06/09/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the relationship between individual bacterial and viral pathogens and disease severity. METHODS Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up). RESULTS Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease. CONCLUSIONS In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.
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Affiliation(s)
- J Xie
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - A Nettel-Aguirre
- Departments of Pediatrics and of Community Health Sciences, Cumming School of Medicine, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, O'Brien Population Health Institute, University of Calgary, Calgary, Alberta, Canada
| | - B E Lee
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - L Chui
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - X L Pang
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - R Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - B Parsons
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - O G Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences and the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - P I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - S Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - J A Dickinson
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - E Hagen
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - L W Svenson
- Analytics and Performance Reporting, Alberta Health Division of Preventive Medicine, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - S E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Canada; School of Public Health, University of Alberta, Edmonton, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - S J Drews
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - R Tellier
- Provincial Laboratory for Public Health, Alberta, Canada; Departments of Pathology and Laboratory Medicine and Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - T Graham
- Alberta Health Services, Edmonton Zone, Alberta, Canada; Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Lavoie
- Population and Public Health, Fraser Health, Surrey, British Columbia, Canada
| | - J MacDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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27
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Stewart A, Vanderkooi OG, Reimer RA, Doyle-Baker PK. Immune response in highly active young men to the 2014/2015 seasonal influenza vaccine. Appl Physiol Nutr Metab 2018; 43:769-774. [PMID: 29481760 DOI: 10.1139/apnm-2017-0683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/13/2023]
Abstract
During the 2009 H1N1 pandemic, individuals with obesity were disproportionately affected by H1N1 with increased levels of mortality and morbidity. This led to questions regarding the potential impact of lifestyle on the effectiveness of immunization. Currently, the research is limited on influenza vaccination and the associated changes in immune response with body composition and physical activity. The purpose of this pilot study was to investigate the potential role of adiposity and physical activity in the immune response elicited by the 2014/2015 seasonal trivalent influenza vaccine. A prospective cohort study examining the 2014/2015 seasonal trivalent influenza vaccine was conducted by collecting baseline and 4-week postvaccination fasting blood samples from 45 male Albertans between the ages of 18 and 35 years. Percent body fat (%BF) was assessed through dual X-ray absorptiometry imagining and physical activity through self-reported survey scores. While no differences in median %BF were associated with seroconversion rates in participants, the median physical activity score was higher among those that did not seroconvert to the vaccine. Significant differences were found for the A/Texas strain (p < 0.01) and a similar trend of lower magnitude observed for the remaining 2 influenza strains. These results suggest that higher physical activity levels may influence immune response to vaccination and that assessing factors beyond those commonly used can be of value when identifying vaccine response in the population.
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Affiliation(s)
- Andrew Stewart
- a Human Performance Lab, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
| | - Otto G Vanderkooi
- b Departments of Paediatrics, Pathology & Laboratory Medicine, Microbiology & Infectious diseases, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Raylene A Reimer
- a Human Performance Lab, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada.,c Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Patricia K Doyle-Baker
- a Human Performance Lab, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada.,d Faculty of Environmental Design, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
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Dunbar MJ, Shah H, Shinde S, Vayalumkal J, Vanderkooi OG, Kirton A. Abstract TMP104: Stroke in Paediatric Bacterial Meningitis. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tmp104] [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] [Indexed: 11/16/2022]
Abstract
Introduction:
Bacterial meningitis is a severe intracranial infection with a high complication rate. Neurological morbidity relates to parenchymal involvement where vascular mechanisms and stroke may predominate. Here, we systematically identified all neonates and children with bacterial meningitis and compared those with and without MRI-confirmed stroke. We hypothesized that patterns of stroke would correlate with causative organism and neurological outcome.
Methods:
Population-based (2.2 million), ten-year retrospective (2002-2012) cross-sectional study in Southern Alberta, Canada. Inclusion criteria were: (1) age from newborn (including prematurity) to 18 years, (2) brain MRI including DWI during admission, and (3) laboratory confirmed acute bacterial meningitis. Demographics, clinical presentations, risk factors, and laboratory findings were extracted. Original imaging was blindly reviewed and classified for stroke and injury pattern. Outcomes were extrapolated to the Pediatric Stroke Outcome Measure (PSOM).
Results:
Twenty-four patients had confirmed bacterial meningitis and acute MRI (6 neonates, 83% male, and 18 children, mean age 3.14+/-3.9 years, 67% male). Arterial ischemic stroke was confirmed in 9/24 (38%). Strokes were often multifocal (89%), particularly in neonates (100%). Subjects with stroke were more likely to have longer duration of illness prior to presentation, meningismus, prolonged fever, seizures, and new focal neurological signs. The most common organisms were S. pneumonia in older children (44%) and group B streptococcus in neonates (33%). Three patients received steroids, 3 ASA and 1 heparin and ASA. Mortality was 22% in children with stroke and zero in those without (p=0.16). Survivors with stroke were more likely to have motor deficit (71% vs. 25%, p = 0.07), cognitive deficit (75% vs. 38%, p = 0.5), and speech deficit (60% vs. 10%, p = 0.08).
Conclusions:
More than a third of children with bacterial meningitis warranting MRI have stroke. Associations include longer duration of illness, meningismus, focal neurological signs and common causative organisms. Stroke was associated with higher mortality and morbidity, warranting consideration of increased MRI screening and new approaches to treatment.
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Affiliation(s)
| | - Hely Shah
- Alberta Children’s Hosp, Calgary, 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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Peirano G, Gregson DB, Kuhn S, Vanderkooi OG, Nobrega DB, Pitout JDD. Rates of colonization with extended-spectrum β-lactamase-producing Escherichia coli in Canadian travellers returning from South Asia: a cross-sectional assessment. CMAJ Open 2017; 5:E850-E855. [PMID: 29246886 PMCID: PMC5741423 DOI: 10.9778/cmajo.20170041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/14/2022] Open
Abstract
BACKGROUND A previous study in Calgary showed that travel to India was associated with high risk of community-onset infections with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. We performed a follow-up study to determine the rate of rectal acquisition of ESBL-producing E. coli among travellers to South Asia and to identify the behaviours putting such travellers at high risk for acquiring ESBL-producing E. coli. METHODS: The study was performed at a travel clinic in Calgary. Travellers 18 years or older who were planning to visit South Asia for a period of at least 5 days were included. Three rectal swabs were obtained, and 2 questionaires were administered (before and after travel). RESULTS A total of 149 travellers participated between January 2012 and July 2014; of these, 116 (78%) provided rectal swabs upon return to Calgary and completed both pre- and post-travel questionaires. Of the 109 travellers without colonization with ESBL-producing E. coli upon enrollment, 70 (64%) acquired ESBL-producing E. coli during travel. Of the 90 participants who visited India, 66 (73%) were positive for ESBL-producing E. coli upon their return to Calgary. Most ESBL-producing E. coli specimens were identified as producing the enzyme CTX-M-15. Behaviours associated with a statistically significant risk of acquiring ESBL-producing E. coli included visiting India (odds ratio [OR] 19.9, 95% confidence interval [CI] 4.5-88.8), consuming meals with the local population (OR 6.9, 95% CI 1.2-39.6), taking any type of antibiotic during travel (OR 4.3, 95% CI 1.3-14.3) and travelling for any purpose other than business (OR 12.4, 95% CI 2.8-55.2). INTERPRETATION In this study, travel to India was associated with the highest risk of acquiring ESBL-producing E. coli relative to travel to other countries in South Asia. Nonbusiness travel, consuming foods with the local population and the use of antibiotics while travelling were associated with an increased risk of acquiring these antibiotic-resistant organisms while in India. Trial registration: ClinicalTrials.gov, no. NCT01296165.
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Affiliation(s)
- Gisele Peirano
- Affiliations: Division of Microbiology (Peirano, Gregson, Pitout), Calgary Laboratory Services; Departments of Pathology and Laboratory Medicine (Peirano, Gregson, Vanderkooi, Pitout), of Medicine (Gregson, Kuhn), of Paediatrics (Kuhn, Vanderkooi) and of Community Health Sciences (Vanderkooi), Cummings School of Medicine, University of Calgary; Department of Production Animal Health (Nobrega), Faculty of Veterinary Medicine, University of Calgary, Calgary, Alta.; Department of Medical Microbiology (Pitout), University of Pretoria, Pretoria, South Africa
| | - Daniel B Gregson
- Affiliations: Division of Microbiology (Peirano, Gregson, Pitout), Calgary Laboratory Services; Departments of Pathology and Laboratory Medicine (Peirano, Gregson, Vanderkooi, Pitout), of Medicine (Gregson, Kuhn), of Paediatrics (Kuhn, Vanderkooi) and of Community Health Sciences (Vanderkooi), Cummings School of Medicine, University of Calgary; Department of Production Animal Health (Nobrega), Faculty of Veterinary Medicine, University of Calgary, Calgary, Alta.; Department of Medical Microbiology (Pitout), University of Pretoria, Pretoria, South Africa
| | - Susan Kuhn
- Affiliations: Division of Microbiology (Peirano, Gregson, Pitout), Calgary Laboratory Services; Departments of Pathology and Laboratory Medicine (Peirano, Gregson, Vanderkooi, Pitout), of Medicine (Gregson, Kuhn), of Paediatrics (Kuhn, Vanderkooi) and of Community Health Sciences (Vanderkooi), Cummings School of Medicine, University of Calgary; Department of Production Animal Health (Nobrega), Faculty of Veterinary Medicine, University of Calgary, Calgary, Alta.; Department of Medical Microbiology (Pitout), University of Pretoria, Pretoria, South Africa
| | - Otto G Vanderkooi
- Affiliations: Division of Microbiology (Peirano, Gregson, Pitout), Calgary Laboratory Services; Departments of Pathology and Laboratory Medicine (Peirano, Gregson, Vanderkooi, Pitout), of Medicine (Gregson, Kuhn), of Paediatrics (Kuhn, Vanderkooi) and of Community Health Sciences (Vanderkooi), Cummings School of Medicine, University of Calgary; Department of Production Animal Health (Nobrega), Faculty of Veterinary Medicine, University of Calgary, Calgary, Alta.; Department of Medical Microbiology (Pitout), University of Pretoria, Pretoria, South Africa
| | - Diego B Nobrega
- Affiliations: Division of Microbiology (Peirano, Gregson, Pitout), Calgary Laboratory Services; Departments of Pathology and Laboratory Medicine (Peirano, Gregson, Vanderkooi, Pitout), of Medicine (Gregson, Kuhn), of Paediatrics (Kuhn, Vanderkooi) and of Community Health Sciences (Vanderkooi), Cummings School of Medicine, University of Calgary; Department of Production Animal Health (Nobrega), Faculty of Veterinary Medicine, University of Calgary, Calgary, Alta.; Department of Medical Microbiology (Pitout), University of Pretoria, Pretoria, South Africa
| | - Johann D D Pitout
- Affiliations: Division of Microbiology (Peirano, Gregson, Pitout), Calgary Laboratory Services; Departments of Pathology and Laboratory Medicine (Peirano, Gregson, Vanderkooi, Pitout), of Medicine (Gregson, Kuhn), of Paediatrics (Kuhn, Vanderkooi) and of Community Health Sciences (Vanderkooi), Cummings School of Medicine, University of Calgary; Department of Production Animal Health (Nobrega), Faculty of Veterinary Medicine, University of Calgary, Calgary, Alta.; Department of Medical Microbiology (Pitout), University of Pretoria, Pretoria, South Africa
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Freedman S, Nettel-Aguirre A, Xie J, Lee B, Chui L, Pang XL, Zhuo R, Parsons B, Dickinson J, Vanderkooi OG, Ali S, Osterreicher L, Lowerison K, Tarr P. Enteropathogen Detection in Children with Diarrhea and/or Vomiting: A Cohort Study Comparing Rectal Flocked Swabs and Stool Specimens. Open Forum Infect Dis 2017. [PMCID: PMC5631954 DOI: 10.1093/ofid/ofx162.081] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Diarrheal stool samples are currently preferred for enteropathogen detection, but they are inconvenient to collect if they are not immediately available, leading to suboptimal return rates and delayed or missed diagnostic opportunities. We sought to compare the enteropathogen yields of rectal swabs and stool specimens in an outpatient cohort of children with diarrhea and/or vomiting. Methods Eligible children were < 18 years of age, with ≥3 episodes of vomiting or diarrhea in 24 hours and <7 days of symptoms. After excluding those enrolled within the prior fortnight, unable to follow-up, having psychiatric illness, neutropenia, or requiring emergent care, we attempted to collect rectal swabs and stool from all participants. Specimens were subjected to testing with the Luminex xTAG Gastrointestinal Pathogen Panel, an in-house 5-virus panel and bacterial culture. Primary outcomes were comparative (submitted paired specimens only) and overall (all specimens, unsubmitted specimens analyzed as negative) yields. We used McNemar’s test to conduct pathogen-specific analyses, and generalized estimating equations to perform global (i.e., any) pathogen analyses with adjustments made for the presence of diarrhea, location, and their interactions with specimen type. Results Of the 1,519 subjects enrolled, 1,147 (75·5%) and 1,514 (99·7%) provided stool and swab specimens, respectively. The proportions of specimens positive for any pathogen were 75.9% (871/1,147) and 67.6% (1,024/1,514); P < 0.0001. Comparative yield adjusted OR in stool relative to swabs were 1.24 (95% CI: 1.11, 1.38) and 1.76 (95% CI: 1.47, 2.11) in children with and without diarrhea at presentation, respectively. Overall concordance analysis yielded a kappa of 0.76 (95% CI: 0.71, 0.80). Paired positive viral specimens had lower median cycle threshold values (i.e., higher viral loads; P < 0·0001) in SSs compared with swabs for all viruses. In overall yield analysis, the proportions positive for a pathogen were 57.3% and 67.4 for stool and rectal swabs, respectively; unadjusted OR: 0.65 (95% CI: 0.59, 0.72) for stool relative to swab. Conclusion Rectal swabs should be performed when enteropathogen identification, and/or rapid detection, is needed, molecular diagnostic technology available, and stool not immediately available. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Jianling Xie
- Alberta Children’s Hospital, Calgary, AB, Canada
| | - Bonita Lee
- University of Alberta, Edmonton, AB, Canada
| | - Linda Chui
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | | | - Ran Zhuo
- University of Alberta, Edmonton, AB, Canada
| | - Brendon Parsons
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | | | | | - Samina Ali
- University of Alberta, Edmonton, AB, Canada
| | | | | | - Phillip Tarr
- Washington University School of Medicine, St. Louis, Missouri
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Vanderkooi OG, Xie J, Lee B, Ali S, Pang XL, Chui L, Payne DC, Tarr P, Zhuo R, Parsons B, Osterreicher L, Kim K, Freedman S. Gastroenteritis Severity: A Prospective Cohort Comparison of Children in Emergency Department and Home Settings. Open Forum Infect Dis 2017. [PMCID: PMC5631245 DOI: 10.1093/ofid/ofx163.883] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background While nearly 2 million children are brought to emergency department (ED) annually due to vomiting and/or diarrhea from acute gastroenteritis (AGE), it is estimated that 90% of AGE cases do not seek medical care. We sought to determine whether the disease severity and enteropathogen burden of disease of children with AGE brought for ED care is different from those cared for at home. Methods Subjects were prospectively recruited by the APPETITE team in pediatric EDs in 2 urban centers and via HealthLink, a province-wide nurse telephone advice line. Eligibility criteria included: < 18 years old, AGE defined by ≥ 3 episodes of vomiting or diarrhea in the preceding 24 hours, and < 7 days of symptoms. The primary outcome was index encounter disease severity quantified using the modified Vesikari Scale (MVS) score. To eliminate the impact of the index encounter on the score we excluded the index ED visit and intervention from all calculations. Secondary objectives included the enteropathogen burden of disease. Two rectal swabs and stool were collected and tested for enteropathogens by enteric bacterial culture, Luminex xTAG GPP, and a 5-virus in-house RT-qPCR panel. Results Between December 9, 2014 and December 31, 2016, 1,623 participants were enrolled with 81.5% from the EDs. Median age was 20.1 months. Children who went to ED were less likely to have a family physician (62 vs. 82%, P < 0.001), more likely to have clinical dehydration (Clinical Dehydration Scale score 3 vs 1, P < 0.001) and vomiting (91 vs. 85%, P = 0.004), previously received IV fluids (4.1 vs. 0.7%, P = 0.001) or been admitted (5.4 vs. 1.3%, P = 0.002). The MVS score was similar between groups when the contribution of the index visit to the score was excluded (8.1 vs. 7.8, P = 0.15). Participants recruited in the ED were not significantly more likely to have bacterial pathogens (8.0 vs. 3.7%, P = 0.09) but were less likely to have viral pathogens identified (64.1 vs. 80.7, P < 0.001). Conclusion Children presenting for ED care had disease severity scores that were similar to children managed at home when the contribution of the index ED visit was accounted for. Viral pathogens were more common in AGE receiving care at home while those presenting to the ED and potentially have a clinically greater likelihood of having a bacterial enteropathogen. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Jianling Xie
- Alberta Children’s Hospital, Calgary, AB, Canada
| | - Bonita Lee
- University of Alberta, Edmonton, AB, Canada
| | - Samina Ali
- University of Alberta, Edmonton, AB, Canada
| | | | - Linda Chui
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Daniel C Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Phillip Tarr
- Pediatric Gastroenterology, Washington University, St. Louis, Missouri
| | - Ran Zhuo
- University of Alberta, Edmonton, AB, Canada
| | - Brendon Parsons
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | | | - Kelly Kim
- University of Calgary, Calgary, AB, Canada
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Freedman S, Xie J, Nettel-Aguirre A, Lee B, Chui L, Pang XL, Zhuo R, Parsons B, Vanderkooi OG, Tarr P, Ali S, Dickinson JA, Hagen E, Svenson LW, MacDonald SE, Drews SJ, Tellier R, Graham T, Lavoie M, Macdonald J. Relationship Between Enteropathogen and Acute Gastroenteritis Disease Severity: A Prospective Cohort Study. Open Forum Infect Dis 2017. [PMCID: PMC5631498 DOI: 10.1093/ofid/ofx163.886] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Little is known about the association between specific enteropathogens and disease severity in outpatient children with acute gastroenteritis. Recent advances in diagnostics enabling the rapid and simultaneous detection of common enteropathogens have become readily available. While such knowledge can be used to optimize therapy it also has the potential to predict disease severity. Such knowledge can aid clinical decision making, can clarify guidance and expectations provided to families, and can guide public health policy. Methods We conducted a prospective cohort study of children with acute gastroenteritis who were brought for emergency department care. The primary outcome measure was the 20-point Modified Vesikari Scale (MVS) score calculated from symptom onset until day14 of follow-up (total MVS score). Stool and/or rectal swab specimens were collected and analyzed for 18 unique pathogens by molecular diagnostic assays (in-house 5 virus panel, Luminex xTAG Gastrointestinal Pathogen Panel) and/or bacterial culture. An enteropathogen was deemed to be present if a candidate pathogen was identified in the rectal swab or stool specimens by any testing method. Binary logistic regression was performed to assess the association between pathogens (including all pathogens as present or not) and disease severity with the dependent variable being the total MVS score categorized as severe (11–20 points) vs.. non-severe (0–10 points). Results The mean total MVS score (SD) was 12.8 (3.2) and 73.0% (807/1102) of participants experienced severe disease. A pathogen was identified in 72.8% (802/1102) of study participants. Rotavirus, norovirus GII and adenovirus were identified in 26.6% (293/1102), 23.0% (253/1102) and 16.0% (176/1102) of participants respectively. After adjusting for other pathogens significant predictors of severe disease were: rotavirus (OR=8.0; 95% CI: 4.8, 13.2), Salmonella (OR=5.4; 95% CI: 1.2, 24.4), adenovirus (OR=2.1; 95% CI: 1.3, 3.3), and norovirus GII (OR=1.8; 95% CI: 1.3, 2.6). Clostridium difficile (OR=1.6; 95% CI: 0.96, 2.6) and Aeromonas (OR=0.97; 95% CI: 0.2, 4.7) were not significantly associated with severe disease. Conclusion In children with acute gastroenteritis, the enteropathogens associated with severe disease included rotavirus, Salmonella, adenovirus and norovirus GII. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Jianling Xie
- Alberta Children’s Hospital, University of Calgary, Clagary, AB, Canada
| | - Alberto Nettel-Aguirre
- Alberta Children’s Hospital Research Institute, O’Brien Population Health Institute, University of Calgary, Calgary, AB, Canada
| | - Bonita Lee
- Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Linda Chui
- University of Alberta, Edmonton, AB, Canada
| | | | - Ran Zhuo
- University of Alberta, Edmonton, AB, Canada
| | - Brendon Parsons
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | | | - Phillip Tarr
- Washington University School of Medicine, St. Louis, Missouri
| | - Samina Ali
- University of Alberta, Edmonton, AB, Canada
| | - James A Dickinson
- Family Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Evan Hagen
- Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
| | - Lawrence W Svenson
- Analytics and Performance Reporting, Alberta Health Division of Preventive Medicine, University of Alberta, Calgary, AB, Canada
| | | | - Steven J Drews
- Provincial Laboratory for Public Health, Edmonton, AB, Canada
| | | | - Tim Graham
- University of Alberta, Edmonton, AB, Canada
| | | | - Judy Macdonald
- Public Health, Alberta Health Services, Calgary, AB, Canada
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Sperou AJ, Dickinson JA, Lee B, Louie M, Pang XL, Chui L, Vanderkooi OG, Freedman SB. Physician perspectives on vaccination and diagnostic testing in children with gastroenteritis: A primary care physician survey. Paediatr Child Health 2017; 22:317-321. [PMID: 29479244 PMCID: PMC5804577 DOI: 10.1093/pch/pxx078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
OBJECTIVES Gastroenteritis remains a common paediatric illness. Little is known about physician knowledge of enteric pathogen diagnostic tests. At the time of study conduct, Alberta lacked a publicly funded rotavirus vaccination program and knowledge of primary care physician perspectives was lacking. We sought to ascertain diagnostic testing methods and to understand knowledge and perceptions regarding enteric pathogen vaccination. METHODS A 30-item electronic survey was distributed across Alberta's five health care zones. The survey was developed by virology, microbiology, paediatrics, family medicine and public health experts. Participants were members of Alberta's Primary Care Networks, the TARRANT network and The Society of General Pediatricians of Greater Edmonton. Study outcomes included: (1) physician knowledge of available diagnostic tests, (2) perspectives regarding stool sample collection and (3) support for an enteric vaccine program. RESULTS Stool culture was reported as the test to identify parasites (47%), viruses (74%) and Clostridium difficile (67%). Although electron microscopy and enzyme immunoassay were used to identify viruses in Alberta during the study period, only 20% and 48% of respondents respectively identified them as tests employed for such purposes. Stool testing was viewed as being inconvenient (62%; 55/89), whereas rectal swabs were thought to have the potential to significantly improve specimen collection rates (82%; 72/88). Seventy-three per cent (66/90) of the respondent physicians support the adoption of future enteric pathogen vaccines. CONCLUSIONS Simplification of diagnostic testing and stool sample collection could contribute to improved pathogen identification rates. Implementation of an enteric vaccine into the routine paediatric vaccination schedule is supported by the majority of respondents.
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Affiliation(s)
- Arissa J Sperou
- Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - James A Dickinson
- Departments of Family Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Bonita Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Marie Louie
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Provincial Laboratory for Public Health, Alberta Health Services, Calgary, Alberta
| | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta
- Provincial Laboratory for Public Health, Alberta Health Services, Edmonton, Alberta
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta
- Provincial Laboratory for Public Health, Alberta Health Services, Edmonton, Alberta
| | - Otto G Vanderkooi
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Stephen B Freedman
- Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and Research Institute, Calgary, Alberta
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Freedman SB, Xie J, Nettel-Aguirre A, Lee B, Chui L, Pang XL, Zhuo R, Parsons B, Dickinson JA, Vanderkooi OG, Ali S, Osterreicher L, Lowerison K, Tarr PI. Enteropathogen detection in children with diarrhoea, or vomiting, or both, comparing rectal flocked swabs with stool specimens: an outpatient cohort study. Lancet Gastroenterol Hepatol 2017; 2:662-669. [PMID: 28712662 DOI: 10.1016/s2468-1253(17)30160-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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] [Received: 03/13/2017] [Revised: 05/10/2017] [Accepted: 05/18/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Enteropathogen detection traditionally relies on diarrhoeal stool samples, but these are inconvenient to collect if they are not immediately available, leading to suboptimum return rates of samples and delayed or missed diagnostic opportunities. We sought to compare the enteropathogen yields of rectal swabs and stool specimens in children with diarrhoea or vomiting, or both. METHODS The Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) did a study in three outpatient cohorts in Calgary and Edmonton (AB, Canada)-children enrolled in the Pediatric Emergency Research Canada emergency departments, children receiving routine vaccinations at a Calgary health clinic, and symptomatic children who met criteria for treatment at home. Eligible participants were children younger than 18 years, with at least three episodes of vomiting or diarrhoea in the preceding 24 h and fewer than 7 days of symptoms. After excluding those enrolled within the previous fortnight, unable to follow-up, or having psychiatric illness, neutropenia, or requiring emergent care, we attempted to collect rectal swabs and stool from all participants. Specimens were tested with the multianalyte assay Luminex xTAG Gastrointestinal Pathogen Panel, an in-house five-virus panel and bacterial culture. Primary outcomes were comparative yield (calculated as the proportion of submitted paired specimens only in which at least one pathogen was identified) and overall yield (which calculated the proportion of study participants in whom at least one pathogen was identified in all specimens, where unsubmitted specimens were analysed as negative). We used McNemar's test to do pathogen-specific analyses, and generalised estimating equations (GEE) for the global (ie, any) pathogen analyses, with adjustments made for the presence of diarrhoea, location, and their interactions with specimen type. FINDINGS Between Dec 12, 2014, and Aug 31, 2016, we studied 1519 eligible participants, 1147 (76%) of whom provided stool specimens and 1514 (>99%) provided swab specimens. 871 (76%) of 1147 stool specimens and 1024 (68%) of 1514 swabs were positive for any pathogen (p<0·0001). Comparative yield adjusted odds ratios (ORs) for stool specimens relative to swabs were 1·24 (95% CI 1·11-1·38) in children with diarrhoea at presentation and 1·76 (1·47-2·11) in children without diarrhoea. GEE analysis identified an interaction between the presence of diarrhoea and specimen type (p=0·0011) and collection location (p=0·0078). In an overall yield analysis, pathogen yield was 57% (871 of 1519 children) for stool specimens and 67% (1024 of 1519 children) for rectal swabs, with an unadjusted OR of 0·65 (95% CI 0·59-0·72) for stool relative to swab. INTERPRETATION Rectal swabs should be done when enteropathogen identification and rapid detection are needed, appropriate molecular diagnostic technology is available, and a stool specimen is not immediately available. In view of their high yield, we urge that the recommendation against the use of rectal swabs as diagnostic specimens be reconsidered. FUNDING Alberta Innovates-Health Solutions Team Collaborative Research Innovation Opportunity.
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Affiliation(s)
- Stephen B Freedman
- Sections of Emergency Medicine and Gastroenterology, Department of Paediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Cumming School of Medicine Calgary, AB, Canada.
| | - Jianling Xie
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Alberto Nettel-Aguirre
- Departments of Paediatrics and of Community Health Sciences, Cumming School of Medicine, Faculty of Kinesiology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, O'Brien Population Health Institute, University of Calgary, Calgary, AB, Canada
| | - Bonita Lee
- Department of Paediatrics, Faculty of Medicine and Dentistry, Stollery Children's Hospital, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Linda Chui
- Provincial Laboratory for Public Health, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Xiao-Li Pang
- Provincial Laboratory for Public Health, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Ran Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Brendon Parsons
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - James A Dickinson
- Health Sciences Centre, Department of Family Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Otto G Vanderkooi
- Departments of Paediatrics, Microbiology, Immunology, and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences and the Alberta Children's Hospital Research Institute, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Samina Ali
- Department of Paediatrics, Faculty of Medicine and Dentistry, Stollery Children's Hospital, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Lara Osterreicher
- Provincial Clinical Programs, Health Link Alberta, Alberta Health Services, Edmonton, AB, Canada
| | - Karen Lowerison
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Paediatrics, Washington University School of Medicine, St Louis, MO, USA
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Cabaj JL, Nettel-Aguirre A, MacDonald J, Vanderkooi OG, Kellner JD. Influence of Childhood Pneumococcal Conjugate Vaccines on Invasive Pneumococcal Disease in Adults With Underlying Comorbidities in Calgary, Alberta (2000-2013). Clin Infect Dis 2016; 62:1521-6. [PMID: 27105745 DOI: 10.1093/cid/ciw175] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 11/09/2015] [Accepted: 02/19/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pneumococcal conjugate vaccine (PCV) was introduced into Alberta, Canada's routine childhood immunization programs in 2002 (7-valent [PCV7]) and 2010 (13-valent [PCV13]). We assessed the effect of these programs on the epidemiology of invasive pneumococcal disease (IPD) to determine if PCV-associated indirect protection was relatively reduced in adults with underlying comorbidities. METHODS Demographic and clinical data were collected by a prospective, population-based surveillance system in Calgary, Alberta, Canada, from January 2000 to December 2013. An indirect cohort study design was used to assess for changes in the proportion of IPD cases with underlying comorbidities. RESULTS There were 1598 overall and 1346 adult IPD cases from 1 January 2000 to 31 December 2013. Overall IPD incidence decreased 33% (age 0-5 months), 86% (6-23 months), 67% (2-4 years), 26% (5-17 years), 22% (18-64 years), 36% (65-84 years), and 42% (≥85 years) from the prevaccine (January 2000-July 2002) to the post-PCV13 (July 2010-December 2013) period. Over the same timeframe, PCV7 serotype disease incidence declined to ≤1 case per 100 000 persons in all age groups. Neither the proportion of adult cases with immunocompetent comorbidities (relative risk ratio [RRR], 0.93; 95% confidence interval [CI], .62-1.40) nor immunocompromising comorbidities (RRR, 0.99; 95% CI, .61-1.61) differed between the pre-PCV period and post-PCV era. CONCLUSIONS Childhood PCV programs have provided considerable benefit, with substantial declines in overall and vaccine-serotype IPD in vaccinated children and in unvaccinated persons. Conjugate vaccine-associated indirect protection for adults with comorbidities was similar to that for healthy adults.
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Affiliation(s)
| | - Alberto Nettel-Aguirre
- Department of Community Health Sciences Department of Paediatrics and Alberta Children's Hospital Research Institute
| | | | - Otto G Vanderkooi
- Department of Paediatrics and Alberta Children's Hospital Research Institute Departments of Microbiology, Immunology and Infectious Diseases, and Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada
| | - James D Kellner
- Department of Community Health Sciences Department of Paediatrics and Alberta Children's Hospital Research Institute
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Crone M, Tellier R, Wei XC, Kuhn S, Vanderkooi OG, Kim J, Mah JK, Mineyko A. Polio-Like Illness Associated With Outbreak of Upper Respiratory Tract Infection in Children. J Child Neurol 2016. [PMID: 26215391 DOI: 10.1177/0883073815596613] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Poliomyelitis is a historically devastating neurological complication of poliovirus infection. Poliovirus vaccines have decreased the incidence of poliomyelitis to 209 global cases in 2014, with new cases of acute flaccid myelitis primarily associated with nonpolio enteroviruses. Recently, during outbreaks of enterovirus D68 throughout North America and Europe, cases of acute flaccid myelitis have been reported, suggesting another nonpolio enterovirus associated with acute flaccid myelitis. The authors describe 3 patients diagnosed with acute flaccid myelitis during a province-wide outbreak of enterovirus D68 with the virus detected in 2 of the patients. Given the significant morbidity associated with acute flaccid myelitis and potential for nonpolio enterovirus to cause outbreaks, prompt identification and notification of public health authorities are warranted.
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Affiliation(s)
- Megan Crone
- Section of Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Raymond Tellier
- Department of Microbiology, Immunology & Infectious Diseases, and Pathology & Laboratory Medicine, University of Calgary and Provincial Laboratory for Public Health of Alberta, Canada
| | - Xing-Chang Wei
- Department of Diagnostic Imaging, University of Calgary, Alberta, Canada
| | - Susan Kuhn
- Section of Infectious Diseases, Departments of Pediatrics and Medicine, University of Calgary, Alberta, Canada
| | - Otto G Vanderkooi
- Section of Infectious Diseases, Departments of Pediatrics, Pathology & Laboratory Medicine and Microbiology, Immunology & Infectious Diseases, University of Calgary, Alberta, Canada
| | - Jong Kim
- Section of Public Health and Preventative Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jean K Mah
- Section of Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Aleksandra Mineyko
- Section of Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Freedman SB, Lee BE, Louie M, Pang XL, Ali S, Chuck A, Chui L, Currie GR, Dickinson J, Drews SJ, Eltorki M, Graham T, Jiang X, Johnson DW, Kellner J, Lavoie M, MacDonald J, MacDonald S, Svenson LW, Talbot J, Tarr P, Tellier R, Vanderkooi OG. Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE): epidemiology, emerging organisms, and economics. BMC Pediatr 2015; 15:89. [PMID: 26226953 PMCID: PMC4521468 DOI: 10.1186/s12887-015-0407-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/15/2015] [Indexed: 01/05/2023] Open
Abstract
Background Each year in Canada there are 5 million episodes of acute gastroenteritis (AGE) with up to 70 % attributed to an unidentified pathogen. Moreover, 90 % of individuals with AGE do not seek care when ill, thus, burden of disease estimates are limited by under-diagnosing and under-reporting. Further, little is known about the pathogens causing AGE as the majority of episodes are attributed to an “unidentified” etiology. Our team has two main objectives: 1) to improve health through enhanced enteric pathogen identification; 2) to develop economic models incorporating pathogen burden and societal preferences to inform enteric vaccine decision making. Methods/Design This project involves multiple stages: 1) Molecular microbiology experts will participate in a modified Delphi process designed to define criteria to aid in interpreting positive molecular enteric pathogen test results. 2) Clinical data and specimens will be collected from children aged 0–18 years, with vomiting and/or diarrhea who seek medical care in emergency departments, primary care clinics and from those who contact a provincial medical advice line but who do not seek care. Samples to be collected will include stool, rectal swabs (N = 2), and an oral swab. Specimens will be tested employing 1) stool culture; 2) in-house multiplex (N = 5) viral polymerase chain reaction (PCR) panel; and 3) multi-target (N = 15) PCR commercially available array. All participants will have follow-up data collected 14 days later to enable calculation of a Modified Vesikari Scale score and a Burden of Disease Index. Specimens will also be collected from asymptomatic children during their well child vaccination visits to a provincial public health clinic. Following the completion of the initial phases, discrete choice experiments will be conducted to enable a better understanding of societal preferences for diagnostic testing and vaccine policy. All of the results obtained will be integrated into economic models. Discussion This study is collecting novel samples (e.g., oral swabs) from previously untested groups of children (e.g., those not seeking medical care) which are then undergoing extensive molecular testing to shed a new perspective on the epidemiology of AGE. The knowledge gained will provide the broadest understanding of the epidemiology of vomiting and diarrhea of children to date.
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Affiliation(s)
- Stephen B Freedman
- Department of Pediatrics, Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
| | - Bonita E Lee
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
| | - Marie Louie
- Provincial Laboratory for Public Health (ProvLab, Alberta Health Services), Departments of Microbiology, Immunology & Infectious Disease and Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada.
| | - Xiao-Li Pang
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada.
| | - Samina Ali
- Department of Pediatrics & Emergency Medicine, University of Alberta, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, Stollery Children's Hospital, Edmonton, AB, Canada.
| | - Andy Chuck
- Institute of Health Economics, Edmonton, AB, Canada.
| | - Linda Chui
- University of Alberta, Edmonton, AB, Canada.
| | - Gillian R Currie
- Department of Pediatrics, Alberta Children's Hospital Research Institute, O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Alberta Children's Hospital Research Institute, O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
| | - James Dickinson
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Steven J Drews
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada.
| | - Mohamed Eltorki
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada.
| | - Tim Graham
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Xi Jiang
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
| | - David W Johnson
- Departments of Pediatrics and Physiology and Pharmacology, Section of Pediatric Emergency Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
| | - James Kellner
- Department of Pediatrics, Section of Infectious Diseases, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
| | - Martin Lavoie
- Alberta Health, University of Alberta, Edmonton, AB, Canada.
| | - Judy MacDonald
- Alberta Health Services, Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Shannon MacDonald
- Department of Pediatrics, University of Calgary, Edmonton, AB, Canada. .,Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
| | | | - James Talbot
- Alberta Health, University of Alberta, Edmonton, AB, Canada.
| | - Phillip Tarr
- Division of Gastroenterology, Washington University, St. Louis, MO, USA.
| | - Raymond Tellier
- Department of Microbiology, Immunology and Infectious Disease, University of Calgary, Calgary, AB, Canada.
| | - Otto G Vanderkooi
- Department of Pediatrics, Section of Infectious Diseases, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. .,Department of Pathology and Laboratory Medicine, Section of Microbiology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. .,Department of Microbiology, Immunology & Infectious Diseases, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
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Bettinger JA, Rouleau I, Gariépy MC, Bowie WR, Valiquette L, Vanderkooi OG, Kellner JD, Coleman BL, McNeil SA, McCarthy A, De Serres G. Successful methodology for large-scale surveillance of severe events following influenza vaccination in Canada, 2011 and 2012. Euro Surveill 2015; 20:21189. [DOI: 10.2807/1560-7917.es2015.20.29.21189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - I Rouleau
- Centre de Recherche du CHU de Québec, Laval University, Canada
| | - M C Gariépy
- Centre de Recherche du CHU de Québec, Laval University, Canada
| | - W R Bowie
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - L Valiquette
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - O G Vanderkooi
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - J D Kellner
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - B L Coleman
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - S A McNeil
- Canadian Center for Vaccinology, IWK Health Centre, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - A McCarthy
- Ottawa Hospital, Ottawa, Ontario, Canada
| | - G De Serres
- Centre de Recherche du CHU de Québec, Laval University, Canada
- Institut National de Santé Publique du Quebec, Quebec City, Quebec, Canada
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Abstract
BACKGROUND Vancomycin is widely used to treat infections caused by methicillin-resistant Staphylococcus aureus. Data for dosing and monitoring of this drug in pediatric patients are lacking, and clinicians who are treating children often follow guidelines established for adults. OBJECTIVES To examine the total daily doses of vancomycin required to reach therapeutic trough levels (i.e., 10-20 mg/L) in infants, children, and adolescents, and to assess the number of pediatric patients in whom therapeutic trough levels are achieved with current empiric doses (40-60 mg/kg daily). METHODS This chart review evaluated patients 1 month to 18 years of age for whom vancomycin was prescribed at a single institution between November 2011 and October 2012. Patients' demographic characteristics, vancomycin dosing parameters, and subsequent steady-state trough concentrations were analyzed. RESULTS Overall, the proportion of patients who reached therapeutic trough levels with current empiric doses was 39% (74 of 188). The mean total daily dose (± standard deviation) required to achieve therapeutic trough levels was 57.8 ± 11.5 mg/kg for patients 1 to 5 months of age, 68.9 ± 15.4 mg/kg for those 6 to 23 months of age, 65.8 ± 13.0 mg/kg for those 2 to 12 years of age, and 55.7 ± 11.8 mg/kg for those 13 to 18 years of age. CONCLUSIONS Common empiric vancomycin dosing regimens (40-60 mg/kg daily) are not high enough to achieve trough levels of 10-20 mg/L in the majority of pediatric patients. Given these data, the authors suggest a starting dose of 60 mg/kg daily for patients 1 to 5 months of age and those 13 to 18 years of age and a starting dose of 70 mg/kg daily for patients 6 months to 12 years of age.
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Affiliation(s)
- Jenny Hoang
- BScPharm, ACPR, is a Medical Teaching Unit Clinical Pharmacist with the Inpatient Pharmacy Department, Peter Lougheed Centre, Calgary, Alberta
| | - Deonne Dersch-Mills
- BScPharm, ACPR, PharmD, is Pharmacy Clinical Practice Leader for Pediatrics and Neonatology, Department of Pharmacy, Alberta Children's Hospital, Calgary, Alberta
| | - Lauren Bresee
- BScPharm, ACPR, MSc, PhD, is Drug Stewardship Pharmacist, Calgary Zone; Residency Research Advisor, Calgary and Cancer Control, Alberta Health Services; and Adjunct Assistant Professor, Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta
| | - Timothy Kraft
- BSP, is a Clinical Pharmacist in the Pediatric Intensive Care Unit, Department of Pharmacy, Alberta Children's Hospital, Calgary, Alberta
| | - Otto G Vanderkooi
- MD, FRCPC, DTMH, is Associate Professor in the Departments of Pediatrics, of Microbiology and Infectious Diseases, and of Pathology and Laboratory Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta
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Adamiak P, Vanderkooi OG, Kellner JD, Schryvers AB, Bettinger JA, Alcantara J. Effectiveness of the standard and an alternative set of Streptococcus pneumoniae multi locus sequence typing primers. BMC Microbiol 2014; 14:143. [PMID: 24889110 PMCID: PMC4057806 DOI: 10.1186/1471-2180-14-143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 05/14/2014] [Indexed: 11/23/2022] Open
Abstract
Background Multi-locus sequence typing (MLST) is a portable, broadly applicable method for classifying bacterial isolates at an intra-species level. This methodology provides clinical and scientific investigators with a standardized means of monitoring evolution within bacterial populations. MLST uses the DNA sequences from a set of genes such that each unique combination of sequences defines an isolate’s sequence type. In order to reliably determine the sequence of a typing gene, matching sequence reads for both strands of the gene must be obtained. This study assesses the ability of both the standard, and an alternative set of, Streptococcus pneumoniae MLST primers to completely sequence, in both directions, the required typing alleles. Results The results demonstrated that for five (aroE, recP, spi, xpt, ddl) of the seven S. pneumoniae typing alleles, the standard primers were unable to obtain the complete forward and reverse sequences. This is due to the standard primers annealing too closely to the target regions, and current sequencing technology failing to sequence the bases that are too close to the primer. The alternative primer set described here, which includes a combination of primers proposed by the CDC and several designed as part of this study, addresses this limitation by annealing to highly conserved segments further from the target region. This primer set was subsequently employed to sequence type 105 S. pneumoniae isolates collected by the Canadian Immunization Monitoring Program ACTive (IMPACT) over a period of 18 years. Conclusions The inability of several of the standard S. pneumoniae MLST primers to fully sequence the required region was consistently observed and is the result of a shift in sequencing technology occurring after the original primers were designed. The results presented here introduce clear documentation describing this phenomenon into the literature, and provide additional guidance, through the introduction of a widely validated set of alternative primers, to research groups seeking to undertake S. pneumoniae MLST based studies.
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Affiliation(s)
| | | | | | | | | | - Joenel Alcantara
- Department of Microbiology, Immunology and Infectious Diseases, 3330 Hospital Dr, NW, Calgary, AB T2N 4 N1, Canada.
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Ricketson LJ, Vanderkooi OG, Wood ML, Leal J, Kellner JD. Clinical features and outcomes of serotype 19A invasive pneumococcal disease in Calgary, Alberta. Can J Infect Dis Med Microbiol 2014; 25:e71-5. [PMID: 24855484 PMCID: PMC4028678 DOI: 10.1155/2014/196748] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED The recent introduction of the seven-valent pneumococcal conjugate vaccine has led to changes in the proportion of disease caused by different serotypes. The serotypes targeted by the vaccine have been reduced, and Streptococcus pneumonia serotype 19A is now the most commonly isolated serotype causing invasive pneumococcal disease. This serotype has been associated with antibiotic resistance. The authors of this article conducted a review of cases of invasive pneumococcal disease diagnosed between 2000 and 2010 in Calgary, Alberta, to examine the disease course of serotype 19A invasive pneumococcal disease compared with other serotypes. BACKGROUND Streptoccocus pneumoniae serotype 19A (ST19A) became an important cause of invasive pneumococcal disease (IPD) after the introduction of the conjugate vaccine. OBJECTIVE To examine the severity and outcome of ST19A IPD compared with non-ST19A IPD. METHODS The Calgary Area Streptococcus pneumoniae Epidemiology Research (CASPER) study collects clinical and laboratory data on all IPD cases in Calgary, Alberta. Analysis was performed on data from 2000 to 2010 comparing ST19A and non-ST19A IPD cases. Adjusted linear and logistic regression models were used to examine outcomes of duration of appropriate intravenous antibiotic therapy and intensive care unit admission, respectively. RESULTS ST19A tended to cause disease in younger patients. ST19A isolates were more often multidrug resistant (19% versus 0.3%; P<0.001). Adjusted logistic regression showed no difference in intensive care unit admission between ST19A and non-ST19A IPD cases (OR 1.4 [95% CI 0.8 to 2.7]). An adjusted linear regression model showed patients <18 years of age with a diagnosis of bacteremia and no risk factors infected with ST19A were, on average, treated with antibiotics 1.4 times (95% CI 1.1 to 1.9) as long as patients with non-19A IPD and the same baseline characteristics. DISCUSSION ST19A IPD was associated with an increase in average time on antibiotics. Although many of the infecting strains of ST19A were within the threshold for susceptibility, they may be sufficiently resilient to require a longer duration of antibiotic therapy or higher dose to clear the infection. CONCLUSIONS ST19A is more common in younger individuals, is more antibiotic resistant and may require longer average treatment duration.
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Affiliation(s)
- Leah J Ricketson
- Department of Pediatrics, University of Calgary, and Alberta Health Services – Calgary Zone, University of Calgary, Calgary, Alberta
| | - Otto G Vanderkooi
- Department of Pediatrics, University of Calgary, and Alberta Health Services – Calgary Zone, University of Calgary, Calgary, Alberta
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta
- Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, Alberta
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta
| | - Melissa L Wood
- Department of Pediatrics, University of Calgary, and Alberta Health Services – Calgary Zone, University of Calgary, Calgary, Alberta
| | - Jenine Leal
- Department of Pediatrics, University of Calgary, and Alberta Health Services – Calgary Zone, University of Calgary, Calgary, Alberta
| | - James D Kellner
- Department of Pediatrics, University of Calgary, and Alberta Health Services – Calgary Zone, University of Calgary, Calgary, Alberta
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta
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Deng X, Church D, Vanderkooi OG, Low DE, Pillai DR. Streptococcus pneumoniaeinfection: a Canadian perspective. Expert Rev Anti Infect Ther 2014; 11:781-91. [DOI: 10.1586/14787210.2013.814831] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Beran TN, Ramirez-Serrano A, Vanderkooi OG, Kuhn S. Humanoid robotics in health care: An exploration of children’s and parents’ emotional reactions. J Health Psychol 2013; 20:984-9. [DOI: 10.1177/1359105313504794] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A new non-pharmacological method of distraction was tested with 57 children during their annual flu vaccination. Given children’s growing enthusiasm for technological devices, a humanoid robot was programmed to interact with them while a nurse administered the vaccination. Children smiled more often with the robot, as compared to the control condition, but they did not cry less. Parents indicated that their children held stronger memories for the robot than for the needle, wanted the robot in the future, and felt empowered to cope. We conclude that children and their parents respond positively to a humanoid robot at the bedside.
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Ricketson LJ, Nettel-Aguirre A, Vanderkooi OG, Laupland KB, Kellner JD. Factors influencing early and late mortality in adults with invasive pneumococcal disease in Calgary, Canada: a prospective surveillance study. PLoS One 2013; 8:e71924. [PMID: 24115997 PMCID: PMC3793008 DOI: 10.1371/journal.pone.0071924] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 03/05/2013] [Accepted: 07/04/2013] [Indexed: 11/29/2022] Open
Abstract
Background Invasive pneumococcal disease continues to be an important cause of mortality. In Calgary, 60% of deaths occur within 5 days of presenting to hospital. This proportion has not changed since before the era of penicillin. The purpose of this study was to investigate what factors may influence death within 5 days of presentation with pneumococcal disease. Methods and Findings Demographic and clinical data from the CASPER (Calgary Area Streptococcus pneumoniae Epidemiology Research) study on 1065 episodes of invasive pneumococcal disease in adults (≥18 years) from 2000 to 2010 were analyzed. Adjusted multinomial regression was performed to analyze 3 outcomes: early mortality (<5 days post-presentation), late mortality (5-30 days post-presentation), and survival, generating relative risk ratios (RRR). Patients with severe disease had increased risk of early and late death. In multinomial regression with survivors as baseline, the risk of early death increased in those with a Charlson index ≥2 (RRR: 6.3, 95% CI: 1.8-21.9); the risk of late death increased in those with less severe disease and a Charlson ≥2 (RRR: 6.1, 95% CI: 1.4-27.7). Patients who never received appropriate antibiotics had 5.6X (95% CI: 2.4-13.1) the risk of early death. Risk of both early and late death increased by a RRR of 1.3 (95% CI: 1.2-1.4) per 5-year increase in age. In multinomial regression, there were no significant differences in the effects of the factors tested between early and late mortality. Conclusions Presenting with severe invasive pneumococcal disease, multiple comorbidities, and older age increases the risk of both early and late death. Patients who died early often presented too late for effective antibiotic therapy, highlighting the need for an effective vaccine.
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Affiliation(s)
- Leah J. Ricketson
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute for Child and Maternal Health, University of Calgary, Calgary, Alberta, Canada
| | - Otto G. Vanderkooi
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin B. Laupland
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James D. Kellner
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute for Child and Maternal Health, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
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Deutschmann MW, Livingstone D, Cho JJ, Vanderkooi OG, Brookes JT. The significance of Streptococcus anginosus group in intracranial complications of pediatric rhinosinusitis. JAMA Otolaryngol Head Neck Surg 2013; 139:157-60. [PMID: 23429946 DOI: 10.1001/jamaoto.2013.1369] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the significance of the Streptococcus anginosus group in intracranial complications of pediatric patients with rhinosinusitis. DESIGN Retrospective cohort study. SETTING Tertiary pediatric hospital. PATIENTS A 20-year review of medical records identified patients with intracranial complications resulting from rhinosinusitis. In the 50 cases identified, S anginosus was the most commonly implicated bacterial pathogen in 14 (28%). Documented data included demographics, cultured bacteria, immune status, sinuses involved, type of intracranial complication, otolaryngologic surgical and neurosurgical intervention, type and duration of antibiotics used, and resulting neurologic deficits. Complications and outcomes of cases of S anginosus group-associated rhinosinusitis were compared with those of other bacteria. MAIN OUTCOME MEASURES The severity and outcomes of intracranial complications of pediatric rhinosinusitis due to S anginosus group bacteria compared with other bacteria. RESULTS Infection caused by the S anginosus group resulted in more severe intracranial complications (P = .001). In addition, patients with S anginosus group-associated infections were more likely to require neurosurgical intervention (P < .001) and develop long-term neurologic deficits (P = .02). Intravenous antibiotics were administered for a longer duration (P < .001) for S anginosus group-associated infections. CONCLUSIONS Rhinosinusitis associated with the S anginosus group should be considered a more serious infection relative to those caused by other pathogens. Streptococcus anginosus group bacteria are significantly more likely than other bacteria to cause more severe intracranial complications and neurologic deficits and to require neurosurgical intervention. A low threshold for intervention should be used for infection caused by this pathogen.
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Affiliation(s)
- Michael W Deutschmann
- Sections of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Scheifele DW, Dionne M, Ward BJ, Cooper C, Vanderkooi OG, Li Y, Halperin SA. Safety and immunogenicity of 2010–2011 A/H1N1pdm09-containing trivalent inactivated influenza vaccine in adults previously given AS03-adjuvanted H1N1 2009 pandemic vaccine: results of a randomized trial. Hum Vaccin Immunother 2013; 9:136-43. [PMID: 23570051 PMCID: PMC3667929 DOI: 10.4161/hv.22619] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 10/16/2012] [Accepted: 10/22/2012] [Indexed: 12/04/2022] Open
Abstract
Many Canadians received a novel AS03-adjuvanted vaccine during the 2009 influenza A/H1N1 pandemic. Longer term implications of adjuvant use were unclear: would anti-H1N1 immune responses persist at high levels and, if so, could that result in increased or unusual adverse effects upon re-exposure to H1N1pdm09 antigen in the trivalent influenza vaccine (TIV) for 2010-11? To answer these questions, adults given AS03-adjuvanted H1N1pdm09 vaccine (Arepanrix®, GSK Canada) 9-10 mo earlier were enrolled in an evaluator-blinded, crossover trial to receive 2010-2011 non-adjuvanted TIV (Fluviral®, GSK Canada) and placebo 10 d apart, in random order. Adverse effects were monitored for 7 d after each injection. Vaccine-attributable adverse event (VAAE) rates were calculated by subtracting rates after placebo from those after vaccine. Blood was obtained pre-vaccination and 21-30 d afterward to measure hemagglutination inhibiting antibody titers. In total, 326 participants were enrolled and 321 completed the study. VAAE rates were low except for myalgia (18.6%) and injection site pain (63.2%). At baseline, H1N1pdm09 titers ≥ 40 were present in 176/325 subjects (54.2%, 95% confidence interval 48.6, 59.7), with a geometric mean titer (GMT) of 37.4 (95% CI 32.8, 42.6). Post-immunization, 96.0% (95% CI 92.3, 97.8) had H1N1pdm09 titers ≥ 40, with GMT of 167.4 (95% CI 148.7, 188.5). Responses to both influenza A strains in TIV were similar, implying no lasting effect of adjuvant exposure. In summary, titers ≥ 40 persisted in only half the participants 9-10 mo after adjuvanted pandemic vaccine but were restored in nearly all after TIV vaccination, with minimal increase in adverse effects.
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Affiliation(s)
- David W Scheifele
- Vaccine Evaluation Center, BC Children’s Hospital, University of British Columbia, Vancouver, BC Canada.
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Vanderkooi OG, Gregson DB, Kellner JD, Laupland KB. Staphylococcus aureus bloodstream infections in children: A population-based assessment. Paediatr Child Health 2012; 16:276-80. [PMID: 22547946 DOI: 10.1093/pch/16.5.276] [Citation(s) in RCA: 24] [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] [Accepted: 04/27/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although Staphylococcus aureus is a major cause of bloodstream infections, population-based data on these infections in children are limited. OBJECTIVE To describe the epidemiology of S aureus bacteremia in children. METHODS Population-based surveillance for all incident S aureus bacteremias was conducted among children (18 years of age or younger) living in the Calgary Health Region (Alberta) from 2000 to 2006. RESULTS During the seven-year study, 120 S aureus bloodstream infections occurred among 119 patients; 27% were nosocomial, 18% health care associated and 56% community acquired. The annual incidence was 6.5/100,000 population and 0.094/1000 live births. A total of 52% had a significant underlying condition, and this was higher for nosocomial cases. Bone and joint (40%), bacteremia without a focus (33%), and skin and soft tissue infections (15%) were the most common clinical syndromes. Infections due to methicillin-resistant S aureus were uncommon (occurring in one infection) and three patients (2.5%) died. CONCLUSIONS S aureus bacteremia is an important cause of morbidity in the paediatric age group. Underlying medical conditions and implanted devices are important risk factors. Methicillin-resistant S aureus and mortality rates are low.
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Scheifele DW, Ward BJ, Dionne M, Vanderkooi OG, Loeb M, Coleman BL, Li Y. Compatibility of ASO3-adjuvanted H1N1pdm09 and seasonal trivalent influenza vaccines in adults: results of a randomized, controlled trial. Vaccine 2012; 30:4728-32. [PMID: 22652402 DOI: 10.1016/j.vaccine.2012.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 04/25/2012] [Accepted: 05/15/2012] [Indexed: 11/25/2022]
Abstract
When Canada chose a novel adjuvanted vaccine to combat the 2009 influenza pandemic, seasonal trivalent inactivated vaccine (TIV) was also available but compatibility of the two had not been assessed. To compare responses after concurrent or sequential administration of these vaccines, adults 20-59 years old were randomly assigned (1:1) to receive ASO3-adjuvanted H1N1pdm09 vaccine (Arepanrix, GSK, Quebec City, Quebec), with TIV (Vaxigrip, Sanofi Pasteur, Toronto) given concurrently or 21 days later. Blood was obtained at baseline and 21 days after each vaccination to measure hemagglutination inhibition (HAI) titers. Adverse effects were assessed using symptom diaries and personal interviews. 282 participants completed the study (concurrent vaccines 145, sequential vaccines 137). HAI titers to H1N1pdm09 were ≥ 40 at baseline in 15-18% of participants and following vaccination in 91-92%. Initially seropositive subjects (titer ≥ 10) had lower H1N1pdm09 geometric mean HAI titers (GMT) after concurrent than separate vaccinations (320.0 vs 476.5, p=0.039) but both exceeded GM responses of initially naïve participants, which were unaffected by concurrent TIV. Responses to TIV were not lower after concurrent than separate vaccination. Adverse event rates were not increased by concurrent vaccinations above those with H1N1pdm09 vaccine alone. This adjuvanted H1N1pdm09 vaccine was immunogenic and compatible with concurrently administered TIV.
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Affiliation(s)
- David W Scheifele
- Vaccine Evaluation Center, University of British Columbia, Vancouver, BC, Canada.
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Bettinger JA, Scheifele DW, Halperin SA, Kellner JD, Vanderkooi OG, Schryvers A, De Serres G, Alcantara J. Evaluation of meningococcal serogroup C conjugate vaccine programs in Canadian children: interim analysis. Vaccine 2012; 30:4023-7. [PMID: 22537988 DOI: 10.1016/j.vaccine.2012.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/06/2012] [Accepted: 04/09/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND To assess antibody titers afforded by meningococcal C- (MenC) tetanus toxoid conjugate vaccine at 12 months of age in three different immunization schedules. METHODS This prospective study included three similar cohorts of healthy infants from 1-dose, 2-dose and 3-dose MenC infant immunization programs. Infants were enrolled at 12 months of age and given the final scheduled dose of MenC-tetanus toxoid conjugate vaccine with sera collected prior to and 1 month after the vaccination. Serum bactericidal activity (SBA) titers ≥ 1:8 were considered protective. RESULTS Before the 12 month dose, participants had significantly different protective titers according to the number of prior doses received: 100% (95% CI 97.6-100%) of infants who had 2 prior doses (at 2 and 4 months) were protected compared to 84.0% (76.7-89.3%) of participants with one dose (at 2 months) and 27.6% (21.0-35.4%) of unvaccinated infants. All subjects were protected after the 12 month MenC dose, but titers were higher with prior priming. CONCLUSIONS Two MenC doses given in infancy afford optimal protection during the first year of life; however, substantial protection was seen after one dose at 2 months.
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Affiliation(s)
- Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, Vancouver, Canada.
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