Scott A Halperin

IWK Health Centre, Halifax, Nova Scotia, Canada

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Publications (331)1296.94 Total impact

  • Donna M MacDougall · Scott A Halperin ·
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    ABSTRACT: Objectives: An increasing number of vaccines are recommended or are being developed for use during pregnancy to protect women, fetuses, and/or newborns. For those already recommended vaccine uptake is variable and well below desired target. We reviewed the literature related to factors that affect a healthcare provider's recommendation and a woman's willingness to be vaccinated during pregnancy. Design: A scoping review of published literature from 2005-2015 was undertaken and all relevant articles were abstracted, summarized and organized thematically. Results: Barriers and facilitators were identified that either decreased or increased the likelihood of a healthcare provider offering and a pregnant woman accepting vaccination during pregnancy. Concern about the safety of vaccines given during pregnancy was the most often cited barrier amongst both the public and providers. Other barriers included doubt about the effectiveness of the vaccine, lack of knowledge about the burden of disease, and not feeling oneself to be at risk of the infection. Major facilitators for maternal immunization included specific safety information about the vaccine in pregnant women, strong national recommendations, and healthcare providers who both recommended and provided the vaccine to their patients. Systems barriers such as inadequate facilities and staffing, vaccine purchase and storage, and reimbursement for vaccination were also cited. Evidence-based interventions were few, and included text messaging reminders, chart reminders, and standing orders. Conclusions: To be effective, there needs to be improvements in the uptake of recommended vaccines during pregnancy. A maternal immunization platform is required that normalizes vaccination practice amongst obstetrical care providers and is supported by basic and continuing education, communication strategy and a broad range of research.
    Human Vaccines & Immunotherapeutics 11/2015; DOI:10.1080/21645515.2015.1101524 · 2.37 Impact Factor
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    ABSTRACT: Methods: Volunteer hospital workers were randomly assigned to groups that either self-administered intradermal influenza vaccine (Intanza(®)) in a nurse-led group or received nurse-administered intramuscular vaccine (Vaxigrip(®)). Research assistants timed vaccination procedures; pre- and post-injection questionnaires assessed acceptability and reactogenicity. Results: 810 adults, 21-69 years of age, from two study sites were vaccinated: 401 self-administered the intradermal vaccine while 409 received their intramuscular vaccine from a nurse. Of those who self-administered for the first time, 98.5% were successful on their first attempt with an additional 1.5% on their second attempt. Acceptability was high: 96% were very or somewhat certain that they administered the vaccine correctly, 83% would choose intradermal influenza vaccine again and of those, 75% would choose self-administration again, if given the choice. It took 51.3-72.6s per person for the nurses to guide the groups through the self-administration process, which was significantly less time than it took to individually administer the intramuscular vaccines (93.6s). Conclusion: Self-administration of intradermal influenza vaccine by people working in healthcare settings is a possible alternative to nurse administered vaccinations, with nurse-led group sessions a good way of teaching the technique while being available to respond to unanticipated problems (NCT01665807).
    Vaccine 11/2015; DOI:10.1016/j.vaccine.2015.10.095 · 3.62 Impact Factor
  • Lauren Davey · Scott A. Halperin · Song F. Lee ·
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    ABSTRACT: Importance: Streptococcus gordonii is a non-cariogenic colonizer of the human oral cavity. To be competitive in the oral biofilm, S. gordonii secretes antimicrobial peptides called bacteriocins that inhibit closely related species. Our previous data showed that mutation of the disulfide oxidoreductase SdbA abolished bacteriocin production. In this study, we show that mutation of SdbA generates a signal that upregulates the CiaRH two-component system, which in turn down-regulates a second two-component system, Com, which regulates bacteriocin expression. Our data show that these systems are also linked in S. gordonii, and reveal that the cell's ability to form disulfide bonds is sensed by the CiaRH system.
    Journal of Bacteriology 11/2015; DOI:10.1128/JB.00800-15 · 2.81 Impact Factor
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    ABSTRACT: Objective: In Canada, rotavirus vaccine is recommended for all infants, but not all provinces/territories have publicly-funded programs. We compared public and provider knowledge, attitudes, and beliefs in a province with a public health nurse-delivered publicly-funded rotavirus vaccination program to a province with a publicly-funded, physician-delivered program. A third province with no vaccination program acted as a control. Design: Information about knowledge, attitudes and beliefs of parents whose children were eligible for the universal program and healthcare providers responsible for administering the vaccine were collected through the use of two validated surveys distributed in public health clinics, physicians' offices and via Early- and post-vaccine program survey results were compared. Results: A total of 722 early implementation and 709 post-implementation parent surveys and 180 early and 141 post-implementation provider surveys were analyzed. Provider and public attitudes toward rotavirus vaccination were generally positive and didn't change over time. More parents post-program were aware of the recommendation and vaccination program, and reported that their healthcare provider discussed rotavirus infection and vaccine with them. Prior to the program across all sites, more physicians than nurses were aware of national recommendations regarding rotavirus vaccine. In the post-survey, however, more nurses were aware of the national recommendations and their provincial universal rotavirus vaccination program. Nurses had higher knowledge scores than physicians in the post survey (p<0.001). Parents of young infants were also more knowledgeable about rotavirus and rotavirus vaccine in the two areas where universal programs were in place (p<0.001). Conclusions: Implementation of a universal rotavirus vaccination program was associated with an increase in knowledge and more positive attitudes toward rotavirus vaccine amongst parents of eligible infants. Nurses involved in a public health-delivered vaccination program were more knowledgeable and had more positive attitudes toward the vaccine than physicians in a jurisdiction where vaccine was physician-delivered.
    Vaccine 10/2015; DOI:10.1016/j.vaccine.2015.09.089 · 3.62 Impact Factor
  • Lauren Davey · Alejandro Cohen · Jason LeBlanc · Scott A Halperin · Song F Lee ·
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    ABSTRACT: Recently, we identified a novel disulfide oxidoreductase, SdbA, in the oral bacterium Streptococcus gordonii. Disulfide oxidoreductases form disulfide bonds in nascent proteins using a CXXC catalytic motif. Typically, the N-terminal cysteine interacts with substrates, while the C-terminal cysteine is buried and only reacts with the first cysteine of the motif. In this study, we investigated the SdbA C(86) P(87) D(88) C(89) catalytic motif. In vitro, SdbA single cysteine variants at the N or C-terminal position (SdbAC86P and SdbAC89A ) were active, but displayed different susceptibility to oxidation, and N-terminal cysteine was prone to sulfenylation. In S. gordonii, mutants with a single N-terminal were inactive and formed unstable disulfide adducts with other proteins. Activity was partially restored by inactivation of pyruvate oxidase, a hydrogen peroxide generator. Presence of the C-terminal cysteine alone (in the SdbAC86P variant) could complement the ΔsdbA mutant and restore disulfide bond formation in recombinant and natural protein substrates. These results provide evidence that certain disulfide oxidoreductases can catalyze disulfide bond formation using a single cysteine of the CXXC motif, including the buried C-terminal cysteine.
    Molecular Microbiology 09/2015; DOI:10.1111/mmi.13227 · 4.42 Impact Factor
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    ABSTRACT: Tetanus, diphtheria and acellular pertussis vaccine (Tdap) is recommended for all adults in Canada but uptake is low. This study measured the knowledge, attitudes, beliefs, and behaviors of Canadian adults to identify potential barriers and facilitators to Tdap uptake. A survey was undertaken on a geographically representative sample of Canadian adults (n=4023) and 8 focus groups (62 participants) were conducted nationwide. The survey revealed that knowledge about pertussis and Tdap was low (38.3% correct answers). Only 36.0% of respondents reported being aware that all adults were recommended to receive Tdap and only 10.7% reported being immunized; 36.7% did not know whether or not they had received Tdap. Respondents who were aware of the immunization recommendations were twice as likely to be immunized (16.6% vs. 8.3%; p<0.001). Only 9.3% believed that their health care provider thought that Tdap was important for adults. The focus group data supported the survey results. Participants wanted information about pertussis and Tdap communicated through a multiple modalities but a recommendation by their family physician was most important to their decision whether or not to be immunized. This study demonstrates that current recommendations for universal adult vaccination with Tdap are not reaching the general public in Canada and an alternative strategy will be required to improve Tdap vaccine uptake.
    Vaccine 09/2015; DOI:10.1016/j.vaccine.2015.09.012 · 3.62 Impact Factor
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    ABSTRACT: Guillain-Barré Syndrome (GBS) cases admitted to Canadian pediatric tertiary care centers were ascertained through active surveillance. From 1996-2012, 246 cases were identified, and 24 (10%) had onset ≤30 days after immunization. Annual rate of post-immunization GBS was 2.0 per 100,000 hospitalizations. Post-immunization GBS was an infrequent cause of pediatric hospitalization.
    The Pediatric Infectious Disease Journal 09/2015; DOI:10.1097/INF.0000000000000903 · 2.72 Impact Factor
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    BMJ Open 09/2015; 5(9):e009062. DOI:10.1136/bmjopen-2015-009062 · 2.27 Impact Factor

  • Canadian Medical Association Journal 08/2015; 187(13). DOI:10.1503/cmaj.150391 · 5.96 Impact Factor
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    ABSTRACT: This systematic review assessed the effectiveness and safety of pharmacotherapy and combined interventions for reducing vaccine injection pain in individuals across the lifespan. Electronic databases were searched for relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear as well as observer-rated distress were critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk (RR) with 95% confidence intervals (CI). Fifty-Five studies that examined breastfeeding (which combines sweet-tasting solution, holding and sucking), topical anesthetics, sweet-tasting solutions (sucrose, glucose), vapocoolants, oral analgesics, and combination of two versus one intervention were included. The following results report findings of analyses of critical outcomes with the largest number of participants. Compared to control, acute distress was lower for infants breastfed during vaccination (n=792): SMD -1.78 (CI: -2.35, -1.22) and before vaccination (n=100): SMD -1.43 (CI: -2.14, -0.72). Compared to control/placebo, topical anesthetics showed benefit on acute distress in children (n=1424): SMD -0.91, (CI: -1.36, -0.47) and self-reported pain in adults (n=60): SMD -0.85 (CI: -1.38, -0.32). Acute and recovery distress was lower for children who received sucrose (n=2071): SMD -0.76, (CI: -1.19, -0.34) or glucose (n=818): [SMD: -0.69, (CI: -1.03, -0.35)] compared to placebo/no treatment. Vapocoolants reduced acute pain in adults [(n=185) SMD -0.78, (CI: -1.08, -0.48)] but not children. Evidence from other needle procedures showed no benefit of acetaminophen or ibuprofen. The administration of topical anesthetics before and breastfeeding during vaccine injections showed mixed results when compared to topical anesthetics alone. There were no additive benefits of combining glucose and non-nutritive sucking (pacifier) compared to glucose or non-nutritive sucking (pacifier) alone or breastfeeding and sucrose compared to breastfeeding or sucrose alone. Breastfeeding, topical anesthetics, sweet-tasting solutions and the combination of topical anesthetics and breastfeeding are effective in reducing vaccine injection pain in infants and children and its use should become the standard of care. In adults, limited data demonstrate some benefit of topical anesthetics and vapocoolants.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
    The Clinical journal of pain 07/2015; 31(10 Suppl). DOI:10.1097/AJP.0000000000000281 · 2.53 Impact Factor
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    ABSTRACT: The tetanus, diphtheria and acellular pertussis vaccine (Tdap) is recommended for all adults in both Canada and the United States. There are few data on the proportion of Canadian adults vaccinated with Tdap; however, anecdotal reports indicate that uptake is low. This study aimed to explore the knowledge, attitudes, beliefs, and behaviors of Canadian health care providers (HCPs) in an attempt to identify potential barriers and facilitators to Tdap uptake. HCPs were surveyed and a geographic and practice representative sample was obtained (n=1167). In addition 8 focus groups and 4 interviews were conducted nationwide. Results from the survey indicate that less than half (47.5%) of all respondents reported being immunized with Tdap themselves, while 58.5% routinely offer Tdap to their adult patients. Knowledge scores were relatively low (63.2% correct answers). The best predictor of following the adult Tdap immunization guidelines was an awareness of, and agreement with those recommendations. Respondents who were aware of the recommendations were more likely to think that Tdap is safe and effective, that their patients were at significant risk of getting pertussis, and to feel that they had sufficient information (p<0.0001 for each statement). Focus group data supported the survey results and indicated that there are substantial gaps in knowledge of pertussis and Tdap amongst Canadian HCPs. Lack of public knowledge around adult immunization, lack of immunization registries, costing differential between Td and Tdap, workload required to deliver the vaccine, and vaccine hesitancy were identified as barriers to compliance with the national recommendations for universal adult immunization and suggestions provided to better translate recommendations to front line practitioners.
    Human Vaccines & Immunotherapeutics 06/2015; 11(9). DOI:10.1080/21645515.2015.1046662 · 2.37 Impact Factor
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    ABSTRACT: Pertussis has reemerged as a problem across the world. To better understand the nature of the resurgence, we reviewed recent epidemiologic data and we report disease trends from across the world. Published epidemiologic data from January 2000 to July 2013 were obtained via PubMed searches and open-access websites. Data on vaccine coverage and reported pertussis cases from 2000 through 2012 from the 6 World Health Organization (WHO) regions were also reviewed. Findings are confounded by the lack of systematic and comparable observations in many areas of the world, but also by the cyclic nature of pertussis with peaks occurring every 3 to 5 years. It appears that pertussis incidence has increased in school-age children in North America and western Europe, where acellular pertussis vaccines are used, but an increase has also occurred in some countries that use whole-cell vaccines. Worldwide, pertussis remains a serious health concern, especially for infants, who bear the greatest disease burden. Factors that may contribute to the resurgence include lack of booster immunizations, low vaccine coverage, improved diagnostic methods, and genetic changes in the organism. To better understand the epidemiology of pertussis and optimize disease control, it is important to improve surveillance worldwide, irrespective of pertussis vaccine types and schedules used in each country.
    The Pediatric Infectious Disease Journal 06/2015; 34(9). DOI:10.1097/INF.0000000000000795 · 2.72 Impact Factor
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    Lauren Davey · Scott A Halperin · Song F Lee ·
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    ABSTRACT: Streptococci secrete small peptides with important biological functions. These peptides are not amenable to standard immunoblotting, and are often detected indirectly using activity assays, or by alternative approaches that may be expensive and laborious. Here we describe an immunoblotting method that enables reproducible detection of these small streptococcal peptides. Copyright © 2015. Published by Elsevier B.V.
    Journal of microbiological methods 04/2015; 114. DOI:10.1016/j.mimet.2015.04.015 · 2.03 Impact Factor
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    Carolyn Sanford · Joanne M Langley · Scott A Halperin · Mitchell Zelman ·
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    ABSTRACT: Rotavirus is the most common cause of diarrhea leading to hospitalization in young children. Rotavirus vaccines are available in Canada but have not been introduced in all provinces. In a controlled trial, two study sites (Prince Edward Island and the Capital District Health Authority (District 9, Nova Scotia) introduced universal rotavirus vaccine programs for infants at two and four months of age beginning 1 December 2010, using public health nurse or general practitioner-delivery models, respectively. A third site (Saint John, NB) served as the non-intervention control setting. Vaccine coverage, rotavirus hospitalizations, intussusception and all-cause diarrhea were monitored. A universal rotavirus vaccine program with >90% coverage was associated with reductions in rotavirus-associated hospitalizations (from a peak of 52.8 hospitalizations/100,000 population to 0 hospitalizations) in infants < 12 months and 1 to < 2 years of age 12 months after program implementation. No apparent reduction occurred in the site with vaccine coverage of < 40%, or in the non-intervention control site. No cases of intussusception were associated with vaccine receipt, and no increase in all-cause diarrhea was observed. A universal infant rotavirus vaccine program with high coverage was associated with reductions in rotavirus and no safety signals; no reduction was observed in settings with low vaccine coverage.
    Human Vaccines and Immunotherapeutics 03/2015; 11(4). DOI:10.1080/21645515.2015.1012028 · 2.37 Impact Factor
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    Matthew Herder · Todd F Hatchette · Scott A Halperin · Joanne M Langley ·
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    ABSTRACT: Increasing the transparency of the evidence base behind health interventions such as pharmaceuticals, biologics, and medical devices, has become a major point of critique, conflict, and policy focus in recent years. Yet the lack of publicly available information regarding the immunogenicity assays upon which many important, widely used vaccines are based has received no attention to date. In this paper we draw attention to this critical public health problem by reporting on our efforts to secure vaccine assay information in respect of 10 vaccines through Canada's access to information law. We argue, under Canadian law, that the public health interest in having access to the methods for these laboratory procedures should override claims by vaccine manufacturers and regulators that this information is proprietary; and, we call upon several actors to take steps to ensure greater transparency with respect to vaccine assays, including regulators, private firms, researchers, research institutions, research funders, and journal editors.
    Human Vaccines & Immunotherapeutics 02/2015; 11(2):498-503. DOI:10.4161/21645515.2014.980194 · 2.37 Impact Factor
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    ABSTRACT: Background: Neisseria meningitidis causes 500 000 cases of septicemia and meningitis worldwide annually, with approximately 200 cases in Canada each year. Previous studies describe a case-fatality rate of 5%-15% and up to 20% of survivors suffering from long-term disability. Methods: This study was performed in Canada between 2002 and 2011; the study area included >50% of the country's population. We identified risk factors associated with death and the development of complications in children and adults admitted to hospital with confirmed invasive meningococcal disease (IMD). Clinical information was obtained from hospital records. Risk factors for death and complications were analyzed by univariate and multivariable analyses. Results: Of 868 individuals hospitalized with IMD, there were 73 deaths (8.4%) and 157 (18%) developed complications. The most common complications were hearing loss (5.4%), skin scarring (5.4%), amputation (3.4%), renal dysfunction (2.6%), and seizures (2.5%). Mortality was independently associated with shock (adjusted odds ratio [aOR], 23.30; P<.0001), age (aOR, 1.02 per 1-year increased age; P<.0001), symptom onset within 24 hours of admission (aOR, 1.80; P=.0471), and admission to the intensive care unit (aOR, 0.41; P=.0196). Development of complications was independently associated with seizures (aOR, 4.55; P<.0001), shock (aOR, 3.10; P<.0001), abnormal platelet count (aOR, 2.14; P=.0002), bruising (aOR, 3.17; P=.0059), abnormal white blood cell count (aOR, 0.52; P=.0100), and prior antibiotic exposure (aOR, 0.27; P=.0273). Conclusions: Outcomes following IMD remain poor in this resource-rich setting in the 21st century. These data identify priorities for clinical management of adults and children with IMD, and provide prognostic information for affected patients and their families and cost-effectiveness analyses for meningococcal vaccine programs.
    Clinical Infectious Diseases 01/2015; 60(8). DOI:10.1093/cid/civ028 · 8.89 Impact Factor
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    ABSTRACT: Objectives: Examine pertussis cycles between 1990 and 2013 and determinants by age group, immunization cohort and province/territory. Methods: National pertussis case reports were used. 2013 data are preliminary. Peak years were those in which incidence rates were above the preceding and proceeding years. Immunization cohorts were defined by year of birth and dates of program implementation by province/territory. Results: Introduction of acellular vaccine and adolescent booster programs occurred in all provinces/territories between 1997 and 2004. From 1990-1998, pertussis peaks occurred every 4 years with a mean increase of 82% from the preceding year and occurred uniformly across all age groups. The largest case contribution shifted from the 1-4 age group (1990-93) to the 5-9 age group (1994-98). From 1999-2007, no national peaks occurred, peaks within age groups were asynchronous, and the largest case contribution shifted from the 5-9 age group (1999), to the 10-14 age group (2000-05), to the 1-4 age group (2006-07). From 2008-2013, peaks occurred every 4 years and across all age groups with a 30% incidence increase in 2008 and 546% increase in 2012. The largest case contribution alternated between the 1-4 and 20+ age groups. Age groups in the adsorbed whole cell cohort contributed the most cases annually until 2006. National peak years were not dependent on the number of peaking provinces/territories but were typically in years with over 80% case contribution from peaking provinces/territories. Conclusions: Canadian pertussis cycles appear to have been altered by acellular vaccine and adolescent booster programs. Booster programs may have interrupted a marching cohort of children primed with adsorbed whole cell vaccine. With 4 year cycles resuming in 2008 and the 2012 peak, a new pattern of pertussis cycles may have begun. Given differences in cyclic patterns and immunization programs by province/territory, data should be examined by region.
    Canadian Immunization Conference, Ottawa, Ontario, Canada; 12/2014
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    ABSTRACT: This survey study compared pre- and post-pandemic knowledge, attitudes, beliefs, and intended behaviors of pregnant women regarding influenza vaccination (seasonal and/or pandemic) during pregnancy in order to determine key factors influencing their decision to adhere to influenza vaccine recommendations. Only 36% of 662 pre-pandemic respondents knew that influenza was more severe in pregnant women, compared to 62% of the 159 post-pandemic respondents. Of the pre-pandemic respondents, 41% agreed or strongly agreed that that it was safer to wait until after the first 3 months to receive the seasonal influenza vaccine, whereas 23% of the post-pandemic cohort agreed or strongly agreed; 32% of pre-pandemic participants compared to 11% of post-pandemic respondents felt it was best to avoid all vaccines while pregnant. Despite 61% of the pre-pandemic cohort stating that they would have the vaccine while pregnant if their doctor recommended it and 54% citing their doctor/nurse as their primary source of vaccine information, only 20% said their doctor discussed influenza vaccination during their pregnancy, compared to 77% of the post-pandemic respondents who reported having this conversation. Women whose doctors discussed influenza vaccine during pregnancy had higher overall knowledge scores (P < 0.0001; P = 0.005) and were more likely to believe the vaccine is safe in all stages of pregnancy (P < 0.0001; P = 0.001) than those whose doctors did not discuss influenza vaccination. The 2009 H1N1 pandemic experience appeared to change attitudes and behaviours of health care providers and their pregnant patients toward influenza vaccination.
    Human Vaccines and Immunotherapeutics 12/2014; 10(12):3629-3641. DOI:10.4161/21645515.2014.980684 · 2.37 Impact Factor
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    ABSTRACT: Highly pathogenic avian influenza A/H5N1 viruses continue to circulate in birds and infect humans causing serious illness and death.Methods In this randomized, observer-blinded study, adults ≥18 years of age (n = 841) received 3.75 or 7.5 μg hemagglutinin antigen (HA) of an AS03-adjuvanted (AS03A or AS03B) A/Indonesia/5/2005 H5N1 (subclade 2.1) vaccine (priming), followed by the same HA dose of AS03-adjuvanted A/turkey/Turkey/1/05 H5N1 (clade 2.2) influenza vaccine as a booster 6 or 18 months after priming; an unprimed group received placebo at Day 0, and 3.75 μg HA of AS03A-adjuvanted booster vaccine at 6 and 18 months. Antibody responses were assessed by hemagglutination-inhibition assay (HI). Microneutralization (MN) antibody and cellular immunoassays were assessed in a subset of participants.ResultsGeometric mean titers (GMTs) and seroconversion rates (SCRs) were higher in primed vs. unprimed subjects against the booster strain 10 days following booster vaccination at month 6 and month 18. After the booster at 18 months, the lower limit of the 97.5% confidence interval for the difference in SCR and GMT ratios between primed and unprimed subjects was >15% and >2.0, respectively, fulfilling the primary endpoint criteria for superiority against the booster strain. MN and cellular immune responses corresponded with the immunogenicity seen in HI measures.Conclusions Adults primed with a dose-sparing oil-in-water adjuvanted H5N1 subclade vaccine had rapid and durable antibody responses to a heterologous subclade boosting vaccine given 6 or 18 months later.
    Vaccine 11/2014; 33(4). DOI:10.1016/j.vaccine.2014.11.018 · 3.62 Impact Factor

  • Medicine 2.0 Scientific Meeting, Maui, Hawaii; 11/2014

Publication Stats

7k Citations
1,296.94 Total Impact Points


  • 1997-2015
    • IWK Health Centre
      Halifax, Nova Scotia, Canada
  • 1989-2015
    • Dalhousie University
      • • Canadian Center for Vaccinology
      • • Division of Infectious Diseases
      • • Department of Pediatrics
      Halifax, Nova Scotia, Canada
  • 2007-2013
    • BC Children's Hospital
      Vancouver, British Columbia, Canada
  • 2009
    • University of Toronto
      Toronto, Ontario, Canada
    • The Ottawa Hospital
      Ottawa, Ontario, Canada
    • Stollery Children's Hospital
      Edmonton, Alberta, Canada
  • 2008
    • University of Oxford
      • Department of Paediatrics
      Oxford, ENG, United Kingdom
  • 2003
    • SickKids
      Toronto, Ontario, Canada
    • St. Paul's Hospital
      Saskatoon, Saskatchewan, Canada
  • 2000-2002
    • University of British Columbia - Vancouver
      Vancouver, British Columbia, Canada
    • Laval University
      Quebec City, Quebec, Canada
    • University of Manitoba
      Winnipeg, Manitoba, Canada
  • 1996
    • Health Canada
      Ottawa, Ontario, Canada
  • 1992
    • Nova Scotia Museum
      Halifax, Nova Scotia, Canada