Manale Ouakki

• Institut National de Santé Publique du Québec (INSPQ)

Importance: Long COVID, a chronic condition following SARS-CoV-2 infection, affects millions of people worldwide and can lead to significant functional impairment. Estimates of long COVID risk after a first COVID-19 infection vary, and data on risk following reinfections remain lacking. Objective: To estimate and compare long COVID risk and severit...

Identifying effective interventions to promote children’s vaccination acceptance is crucial for the health and wellbeing of communities. Many interventions can be implemented to increase parental awareness of the benefits of vaccination and positively influence their confidence in vaccines and vaccination services. One potential approach is using n...

Background In premarketing clinical trials conducted before Omicron emergence, BNT162b2 vaccine efficacy against COVID-19 was 90% in children. We conducted postmarketing evaluation of 1- and 2-dose vaccine effectiveness (VE) against Omicron BA.1, BA.2 and BA.4/5 subvariants in 5- to 11-year olds. Methods We estimated VE against SARS-CoV-2 infectio...

Background: Older adults (aged ≥60 years) were prioritised for COVID-19 booster vaccination due to severe outcome risk, but the risk for this group is also affected by previous SARS-CoV-2 infection and vaccination. We estimated vaccine effectiveness against omicron-associated hospitalisation in older adults by previously documented infection, time...

Background Two- and three-dose BNT162b2 vaccine effectiveness (VE) against SARS-CoV-2 infection, including Delta and Omicron variants, was assessed among adolescents in Canada where first and second doses were spaced longer than the manufacturer-specified 3-week interval. Methods Test-negative design estimated VE against laboratory-confirmed SARS-...

Background. Due to severe outcomes, elderly adults 60 years or older are prioritized for COVID-19 vaccination but accumulated SARS-CoV-2 infection and vaccination likely modifies their risk. We estimated vaccine effectiveness against omicron-associated hospitalisation among elderly adults, by number of doses, prior infection history and time since...

Importance: The Omicron variant is phylogenetically and antigenically distinct from earlier SARS-CoV-2 variants and the original vaccine strain. Protection conferred by prior SARS-CoV-2 infection against Omicron reinfection, with and without vaccination, requires quantification. Objective: To estimate the protection against Omicron reinfection a...

Background There is a paucity of data on vaccine-induced or infection-induced (hybrid or natural) immunity against omicron (B.1.1.529) subvariant BA.2, particularly in comparing the effects of previous SARS-CoV-2 infection with the same or different genetic lineage. We aimed to estimate the protection against omicron BA.2 associated with previous p...

Background and Objectives Two- and three-dose BNT162b2 (Pfizer-BioNTech) mRNA vaccine effectiveness (VE) against SARS-CoV-2 infection, including Delta and Omicron variants, was assessed among adolescents in two Canadian provinces where first and second doses were spaced longer than the manufacturer-specified 3-week interval. Methods Test-negative...

Background We estimated the protection against the Omicron BA.2 variant associated with prior primary infection (PI) due to pre-Omicron or Omicron BA.1 virus, with and without mRNA vaccination. Methods A test-negative case-control study was conducted among healthcare workers (HCWs) tested for SARS-CoV-2 in Quebec, Canada, between March 27 and June...

Background In Canada, vaccination against pertussis (Tdap) during pregnancy has been recommended since 2018, with suboptimal uptake. We aimed to assess the determinants of intention and uptake of Tdap vaccine among pregnant women in Quebec. Methods Participants (< 21 weeks of pregnancy) were recruited in four Quebec regions. Two online surveys wer...

Importance Omicron is phylogenetically- and antigenically-distinct from earlier SARS-CoV-2 variants and the original vaccine strain. Protection conferred by prior SARS-CoV-2 infection against Omicron re-infection, and the added value of vaccination, require quantification. Objective To estimate protection against Omicron re-infection and hospitali...

Background The Canadian COVID-19 immunization strategy deferred second doses and allowed mixed schedules. We compared two-dose vaccine effectiveness (VE) by vaccine type (mRNA and/or ChAdOx1), interval between doses, and time since second dose in two of Canada’s larger provinces. Methods Two-dose VE against SARS-CoV-2 infection or hospitalization...

Background: In Canada, vaccination against pertussis (Tdap) during pregnancy has been recommended since 2018, with suboptimal uptake. We aimed to assess the determinants of intention and uptake of Tdap vaccine among pregnant women in Quebec. Methods: Participants (<21 weeks of pregnancy) were recruited in four Quebec regions. Two online surveys wer...

Contexte : Les résidents de centres d’hébergement et de soins de longue durée (CHSLD) et de résidences privées pour aînés (RPA) ont été vaccinés en priorité contre la maladie à coronavirus 2019 (COVID-19). Vu la pénurie de vaccins de l’hiver 2021, le Comité sur l’immunisation du Québec a recommandé le report de l’administration des deuxièmes doses...

Background: Residents of long-term care facilities (LTCFs) and private residences for seniors (PRSs) were given priority for vaccination against coronavirus disease 2019 (COVID-19). Given the shortage of vaccine in the winter of 2021, the Comité sur l’immunisation du Québec recommended postponing the administration of second doses to ensure more ra...

La pandémie de COVID-19 a affecté de manière disproportionnée les travailleurs de la santé. Nous avons voulu mesurer la séroprévalence du SRAS-CoV-2 chez les travailleurs de la santé dans les hôpitaux du Québec, au Canada, après la première vague de la pandémie, afin d’explorer les facteurs associés à la SRAS-CoV-2-séropositivité. MÉTHODES: Entre l...

Background: The COVID-19 pandemic has disproportionately affected health care workers. We sought to estimate SARS-CoV-2 seroprevalence among hospital health care workers in Quebec, Canada, after the first wave of the pandemic and to explore factors associated with SARS-CoV-2 seropositivity. Methods: Between July 6 and Sept. 24, 2020, we enrolled...

Introduction In Canada, first and second doses of mRNA vaccines against SARS-CoV-2 were uniquely spaced 16 weeks apart, but the duration of single-dose protection remains uncertain. We estimated one- and two-dose mRNA vaccine effectiveness (VE) among healthcare workers (HCWs) in Quebec, Canada including protection against varying outcome severity,...

Concerns were raised about HPV vaccination possibly leading to riskier sexual behavior. We assessed sexual behaviors, risk of sexually transmitted infection, and attendance to cervical cancer screening by HPV vaccinated and unvaccinated young women. In this analysis, 1475 questionnaires completed by women aged 17–29 years were included. The majorit...

Introduction In Canada, first and second doses of mRNA vaccines against SARS-CoV-2 were uniquely spaced 16 weeks apart, but the duration of single-dose protection remains uncertain. We estimated one- and two-dose mRNA vaccine effectiveness (VE) among healthcare workers (HCWs) in Quebec, Canada including protection against varying outcome severity,...

Background The incidence of health-care-associated Clostridioides difficile infections has been declining in the Canadian province of Quebec since 2015. We examined whether changes in high-risk antibiotic use could account for this decrease, as reported in other jurisdictions. Methods We did a retrospective interrupted time-series analysis of 12 h...

Multicomponent interventions are effective in improving vaccine coverage. However, few studies have assessed their effect on timely vaccination. The aim of this study was to compare the proportion of children with vaccine delays at 2- and 12-month visits according to whether or not health centers have participated in an action research project on t...

A number of countries have implemented vaccination in pregnancy as a strategy to reduce the burden of influenza and pertussis. The aim of this study was to assess the involvement of Canadian maternity care providers in administration of vaccines to their pregnant patients. A cross-sectional web-based survey was sent to family physicians, obstetrici...

Background: Monitoring vaccination coverage is an essential component of vaccination program evaluation. In Québec (Canada), children vaccination coverage surveys are conducted every two years since 2006. The objectives of this study were to evaluate the impact of supplementing data based on vaccination booklets with data from vaccine providers, o...

The main objective of this post hoc analysis is to compare the magnitude of the immune response to HPV31/33/45/52 and 58 after a dose of 9vHPV vaccine given to naïve (previously unvaccinated) subjects and subjects previously vaccinated with a dose of 2vHPV or 4vHPV vaccine. Results from two clinical trials conducted in the same region, in comparabl...

Background Many countries are grappling with growing numbers of parents who delay or refuse recommended vaccinations for their children. This has created a need for strategies to address vaccine hesitancy (VH) and better support parental decision-making regarding vaccination.AimTo assess vaccination intention (VI) and VH among parents who received...

The objective of this analysis was to compare the anti-HPV GMTs and their distribution after a 6- month or a 3-8 year interval between two HPV vaccine doses. The results from two clinical trials, conducted by the same team in the same region, with serological assays performed at the same laboratory using the same ELISA methodology were compared. In...

Background Vaccination has a huge public health impact. Maintaining vaccine coverage is key to avoid the devastating consequences of resurgence. In the Province of Québec, vaccine coverage in young children are sub-optimal, mostly due to ambivalence toward vaccine safety and efficacy. We previously conducted a regional study in the Québec’s Eastern...

Background Timeliness in the administration of recommended vaccines is often evaluated using vaccine delays and provides more information regarding the susceptibility of children to vaccine-preventable diseases compared with vaccine coverage at a given age. The importance of on-time administration of vaccines scheduled at the first visit is well do...

Objective: Influenza vaccine uptake among Canadian pregnant individuals is suboptimal. Failure to incorporate vaccination into routine prenatal care and a lack of recommendations from healthcare providers are recognized as barriers to vaccination. The aim of this study was to assess Canadian maternity care providers' knowledge, attitudes, and prac...

Background To address a high incidence of serogroup B invasive meningococcal disease (IMD-B) in the Saguenay–Lac-Saint-Jean region, Quebec, Canada, a mass vaccination campaign targeting nearly 60,000 individuals ≤20 years old was launched in May 2014. Because of the limited clinical experience with the four-component meningococcal B vaccine (4CMenB...

Background: Limited data is available on the use of different HPV vaccines in the same subjects. We evaluated the immunogenicity and safety of a mixed vaccination schedule with one dose of nonavalent (9vHPV) and one dose of bivalent vaccine (2vHPV) administered in different order versus two doses of 9vHPV vaccine. Methods: 371 girls and boys age...

The objective of this study was to assess the persistence of antibodies after a single dose of quadrivalent HPV vaccine (4vHPV) and the effect of a dose of nonavalent HPV vaccine (9vHPV) given 3–8 years later. Such data might be of interest in the decision-making process regarding the 2-dose course completion in non-compliant vaccinees in jurisdict...

Background: Vaccine hesitancy (VH) is a growing problem. The first step in addressing VH is to have an understanding of who are the hesitant individuals and what are their specific concerns. The aim of this survey was to assess mothers’ level of vaccine hesitancy and vaccination knowledge, attitudes, and beliefs. Methods: Mothers of newly-born infa...

Context: Between 2004 and 2016, in the province of Quebec (Canada), 4 new antigens were added in the early childhood vaccine schedule from birth to 18 months, increasing the number of injections or doses needed from 7 to 12. These additions may have decreased the proportion of children who had received all recommended vaccines. Objectives: To asse...

The theory of risk compensation suggests that the relative assurance of the protection from any preventive intervention could be associated with an increase in risky behaviours. Some fear that HPV vaccination may lead to an increase in unfavourable sexual health outcomes. Objective: To test whether receiving an additional dose of Q-HPV vaccine betw...

Parental decision making about childhood vaccinations is complex and multidimensional. There is a perception that the number of parents having concerns regarding childhood vaccinations has been increasing in Canada. The aim of this study was to explore vaccine hesitancy among Canadian parents and to examine factors associated with a parent's intent...

A mass vaccination campaign with the 4CMenB vaccine (Bexsero®) was launched in a serogroup B endemic area in Quebec. A study was conducted to assess parents’ and adolescents’ opinions about the acceptability of the vaccine before and after the campaign (two telephone surveys). This paper reports the results of the second survey and describes the fa...

“Vaccine hesitancy” is a concept now frequently used in vaccination discourse. The increased popularity of this concept in both academic and public health circles is challenging previously held perspectives that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. A consultation study was designed to assess th...

Author List. (PDF)

Questions asked during the First questionnaire and Second questionnaire. (PDF)

Paresthesia was the third-most-common adverse event following immunization (AEFI) with 2009 monovalent AS03-adjuvanted A(H1N1)pdm09 vaccine in Quebec, Canada and was also reported in Europe. This study assessed clinical features and risk factors associated with this unexpected AEFI. Reports to the passive surveillance system were summarized. A case...

Background. In 1994, Canada committed to eliminate measles by the year 2000. This report presents the epidemiology of measles in Canada between 2002 and 2013 and its implications in sustaining measles elimination. Methods. Cases included individuals reported to the Canadian Measles and Rubella Surveillance System with confirmed measles. Results. In...

Purpose: This randomized, blinded study evaluated the immunogenicity and safety of a booster dose of Gardasil (qHPV) or Cervarix (bHPV) when administered to 12-13 year-old girls who were vaccinated at the age of 9-10 with two doses of qHPV (0-6 months). Methods: 366 out of 416 eligible girls participated in this follow-up study. Antibody titers wer...

Context: An association between an adjuvanted (AS03) A/H1N1 pandemic vaccine and narcolepsy has been reported in Europe. Objective: To assess narcolepsy risk following administration of a similar vaccine in Quebec. Design: Retrospective population-based study. Setting: Neurologists and lung specialists in the province were invited to report...

Background: No immunogenicity data has been reported after a single dose of the quadrivalent HPV vaccine (qHPV-Gardasil®) and no data are available on co-administration of this vaccine with the HAV/HBV vaccine (Twinrix-Junior®). Two pre-licensure studies reported similar anti-HPV but lower anti-HBs titers when co-administering HPV and HBV vaccines...

Background The role of viral load in human metapneumovirus (HMPV) disease severity has not yet been clearly determined. Objective We evaluated the importance of viral load along with other factors in HMPV disease severity among children aged <3 years old. Study design HMPV-positive cases were selected from a cohort of outpatients and hospitalized...

Objective: A previous measles outbreak investigation in a high school in Quebec, Canada identified 2-dose vaccine effectiveness of 94%. The risk of measles in 2-dose recipients was significantly higher (2-4 times) when measles vaccine was first administered at 12 versus ≥ 15 months of age, with no significant effect of the age at second dose. Gene...

Anaphylaxis after trivalent influenza vaccination is typically reported at a rate of <1 per million doses. In Quebec, Canada, anaphylaxis following administration of the monovalent AS03-adjuvanted H1N1pdm09 vaccine was reported through passive surveillance at a rate of 8 per million doses administered. This was 20 times higher than the reporting ra...

Background and aims: Recent studies have shown no detectable antibodies and no response to a challenge dose of vaccine 10-20 y after receiving low doses (2.5-5 µg) of recombinant hepatitis B vaccine during first months of life. Little information is available on long-term persistence of immunity after vaccinating pre-adolescents with low doses of...

The persistence of antibody obtained post-vaccination of preadolescents with three doses of Engerix-B and the effect of a booster administered 5, 10 or 15years later were monitored in 663vaccines. Five, 10 and 15years post-vaccination >94% of subjects had detectable antibodies and 88.2%, 86.4% and 76.7% had a titre ≥10IU/L; GMTs were 269IU/L, 169IU...

Background This study assessed the short and the long term safety of the 2009 AS03 adjuvanted monovalent pandemic vaccine through an active web-based electronic surveillance. We compared its safety profile to that of the seasonal trivalent inactivated influenza vaccine (TIV) for 2010–2011. Methodology/Principal Findings Health care workers (HCW) v...

We looked for cross-reactive antibodies in 122 persons with paired serum samples collected during the 2009 pandemic of influenza virus A(H1N1)pdm09. Eight (12%) of 67 persons with A(H1N1)pdm09 infection confirmed by reverse transcription PCR and/or serology also seroconverted to the seasonal A/Brisbane/59/2007 (H1N1) virus, compared with 1 (2%) of...

In Canada, several new vaccines were recently approved for clinical use or are expected to be soon. Decision-makers are faced with the choice whether or not to include these vaccines in publicly funded vaccination programs. The aim of this study was to assess Canadian pediatricians' and family physicians' opinions regarding 7 new vaccines, and perc...

Human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) are leading pediatric pathogens. However, risk factors for severe hMPV disease remain unknown. We comparatively assessed environmental, host, and viral determinants for severe hMPV and RSV infections. We studied a prospective cohort of >1000 children aged <3 years hospitalized in or...

In 2011, >750 cases of measles were reported in Quebec, Canada, where a routine 2-dose measles immunization schedule, in which measles vaccine is given at 12 and 18 months of age, had been in effect since 1996. Effectiveness of this schedule was assessed during a high school outbreak. Cases were identified by passive followed by active surveillance...

A school absenteeism surveillance system was implemented in the province of Quebec, Canada during the second wave of the 2009 H1N1 pandemic. This paper compares this surveillance approach with other available indicators. All (3432) elementary and high schools from Quebec were included. Each school was required to report through a web-based system a...

Parental immunization has been recommended as a "cocoon" strategy to prevent serious pertussis outcomes in early infancy. We illustrate the high number needed to vaccinate (NNV) for this program based on recent epidemiologic data from the provinces of Québec and British Columbia (BC), Canada. Surveillance trends were summarized for the period 1990-...

In 2009, several countries used the ASO3-adjuvanted pandemic A/H1N1 vaccine. We assessed the persistence of antibody and the priming induced by a single paediatric dose of this vaccine in children. Children aged 15-120 months vaccinated one year before with the ASO3-adjuvanted monovalent pandemic vaccine were tested for the presence of antibody aga...

Serology improves influenza diagnosis by capturing cases missed by reverse transcriptase PCR (RT-PCR). We prospectively evaluated microneutralization and hemagglutination inhibition assays for 2009 influenza A (H1N1) virus diagnosis among 24 RT-PCR-confirmed cases and 98 household contacts. Compared to hemagglutination inhibition, microneutralizati...

Emergency department (ED) presentation of pediatric pandemic H1N1 (pH1N1) infection is not well characterized. Our objective was to describe the clinical manifestations of pH1N1 in the pediatric ED. We also compared these characteristics to seasonal influenza A, and explored risk factors for pH1N1 hospitalization. We conducted a retrospective cohor...

To estimate the burden of acute otitis media (AOM) on Canadian families. Telephone survey using random-digit dialing. All Canadian provinces between May and June 2008. Caregivers of 1 or more children aged 6 months to 5 years. Caregivers' reports on the number of AOM episodes experienced by the child in the past 12 months, as well as disease charac...

Vaccine coverage (VC) at a given age is a widely-used indicator for measuring the performance of vaccination programs. However, there is increasing data suggesting that measuring delays in administering vaccines complements the measure of VC. Providing feedback to vaccinators is recognized as an effective strategy for improving vaccine coverage, bu...

Characterizing household transmission of the 2009 pandemic A/H1N1 influenza virus (pH1N1) is critical for the design of effective public health measures to mitigate spread. Our objectives were to estimate the secondary attack rates (SARs), the proportion of asymptomatic infections, and risk factors for pH1N1 transmission within households on the ba...

Because influenza vaccine contains some residual egg protein, there is a theoretic risk of anaphylaxis when vaccinating patients with egg allergy. The objective of this study was to estimate the risk of anaphylaxis in children with egg allergy administered an adjuvanted monovalent 2009 pandemic influenza A/H1N1 influenza vaccine (Arepanrix; GlaxoSm...

The negative consequences of acute otitis media (AOM) on the quality of life (QOL) of children and their families need to be measured to assess benefits of preventive interventions. A new questionnaire was specifically designed for use in telephone surveys. A random sample of Canadian families was selected using random-digit dialling. Caregivers of...

One of the main determinants of public immunization success is health professionals' support and recommendations. Little is known about the physicians' level of support and intentions regarding A(H1N1) pandemic influenza vaccination. The aim of this survey was to document Canadian family physicians' and paediatricians' knowledge, attitudes and prac...

The objective of this study was to describe the offer and accessibility of vaccination services for adolescents and adults so they can be adapted to needs in the future. A descriptive cross-sectional study was carried out among the 81 medical clinics that offer vaccination services in a region of Québec. The response was 70% (57/81). Over 90% of cl...

In Quebec, the pneumococcal conjugate vaccine was available on the private market as early as 2001 and has been included in the publicly funded immunization program since December 2004. To compare the advantages and limitations of two different sources for assessing vaccination coverage in the target population of children and to evaluate the impac...

In Canada, a 7-valent pneumococcal conjugate vaccine (PCV-7) was licensed in 2001, and free vaccination of children <5 years of age was offered in December 2004 in the province of Quebec. To describe the frequency of physician claims for otitis media (OM) in relation to PCV-7 coverage during the period from 1996 to 2007. The monthly frequency of OM...

To examine parents' knowledge, attitudes and beliefs regarding acute otitis media (AOM) and parents' willingness to vaccinate their children with new vaccine offering larger spectrum of protection against AOM. Telephone survey conducted in a stratified sample of household in 10 Canadian provinces using random-digit dialling methodology. Parents of...

In 2001, a mass immunization campaign was implemented in the province of Quebec, Canada, using a new serogroup C meningococcal conjugate vaccine (C-MCV). To describe methodological difficulties in the investigation of the mortality risk associated with administration of C-MCV using large administrative databases, and to present possible solutions....

In most countries registered nurses play a key role in vaccination. The number of recommended childhood vaccines has increased and several other new vaccines are in the implementation phase or are being considered for public programs. Little is known about nurses' perceived usefulness of recommended vaccines and no recent study has assessed nurses'...

This paper is a report of a survey: (1) to document nurses' knowledge, attitudes and information needs regarding human papillomavirus prevention and (2) to determine factors associated with their willingness to recommend human papillomavirus vaccines. Persistent infection with human papillomavirus has been causally linked to cervical cancer. Two hu...

We assessed the scientific basis and practical implications of recommendations made since the late 1990s to offer rabies postexposure prophylaxis (RPEP) for occult bat encounters, including recommendations to offer RPEP to persons with bedroom exposure to a bat while sleeping without evidence of direct physical contact. The number needed to treat a...

In Canada, a pneumococcal conjugate vaccine was licensed in 2001, and in the province of Quebec, a publicly-funded program was implemented for high-risk children in 2002, using a 4-dose schedule, and for all children in 2004, using a 3-dose schedule. To describe the epidemiology of hospitalized pneumonia in the population aged <5 years. Hospital di...

In the province of Quebec, a population-based study of Guillain-Barré syndrome (GBS) was conducted at the time of a mass immunization campaign against meningococcal disease, in 2001. The study population included residents aged 2 months to 20 years observed from November 1st, 2000 to December 31, 2002, representing 4,075,465 person-years of observa...

The objective of this work was to assess the opinions of public health professionals (PHPs) about routinely recommended and new vaccines, and to evaluate the feasibility of using a modified Basic Priority Rating System (BPRS) approach to prioritize new immunization programs. One hundred and thirty six PHPs were invited to participate in the survey...

Investigations conducted by public health in Quebec, Canada, following report of human exposure to a bat were reviewed to evaluate the implementation of the recommendation for rabies post-exposure prophylaxis (RPEP) for household bat exposure (without documented direct contact). Of all RPEP recommended, 12% was for direct bat contact with bite, 7%...

To assess the risk of Guillain-Barré syndrome (GBS) following administration of meningococcal serogroup C-CRM197 conjugate vaccine, provincial immunization records were linked with hospital discharge records, and medical charts were reviewed. In the cohort of 1.9 million individuals (age, 2 months to 20 years), observed postvaccination frequencies...

Palivizumab is a humanized monoclonal antibody that prevents severe human respiratory syncytial virus (HRSV) infections. We determined the etiology of respiratory viral infections in palivizumab recipients, and monitored the clinical outcome and HRSV genotype in HRSV-infected infants. Nasopharyngeal aspirates (NPAs) were collected from children rec...

Objective To document counselling practices of general practitioners concerning lifestyle habits in the Capitale-Nationale region (Quebec City and area), from the patient’s perspective. Method A cross-sectional telephone survey was carried out in 2006 among 482 patients (18–74 years of age) recruited in 11 medical clinics employing 84 general prac...

To document counselling practices of general practitioners concerning lifestyle habits in the Capitale-Nationale region (Quebec City and area), from the patient's perspective. A cross-sectional telephone survey was carried out in 2006 among 482 patients (18-74 years of age) recruited in 11 medical clinics employing 84 general practitioners. At the...

We assessed Canadian obstetrician/gynaecologists', family physicians' and paediatricians' knowledge, attitudes, and beliefs about HPV infection and prevention, as well as factors associated with willingness to prescribe HPV vaccines. A self-administered, anonymous questionnaire was mailed to 2500 physicians. The participation rate was 51%. Overall,...

The Pap test has been used for cervical cancer screening for more than four decades. A human papillomavirus (HPV) vaccine has been approved for use in Canada and is commercially available now. These two preventive interventions should be considered simultaneously. General population support is an important factor for the successful combination of t...

Each year, approximately 42 million trips are made outside Canada, and this number is constantly rising.1,2 The increasing number of trips is largely attributable to visits of tropical and subtropical areas, where hygiene and health care standards may be different than those existing in North America. While hepatitis A (HA) is the most common vacci...

In spring 2002, a mass immunization campaign using a 23-valent pneumococcal polysaccharide vaccine (23-PPV) was launched in order to control an outbreak of severe pneumonia caused by a virulent clone of serotype 1 Streptococcus pneumoniae in Nunavik, Quebec, Canada. The objective of the study was to evaluate the impact of this campaign on the incid...