Scott A Halperin

Dalhousie University, Halifax, Nova Scotia, Canada

Are you Scott A Halperin?

Claim your profile

Publications (348)1302.15 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Vaccine coverage amongst adults for recommended vaccines is generally low. In Canada and the US, pharmacists are increasingly becoming involved in the administration of vaccines to adults. Methods: This study measured the knowledge, attitudes, beliefs, and behaviors of Canadian adults and health care providers regarding pharmacists as immunizers. Surveys were undertaken on geographically representative samples of Canadian adults (n=4023) and health care providers (n=1167) and 8 focus groups each were conducted nationwide with adults and health care providers. Results: Provision of vaccines by pharmacists was supported by 64.6% of the public, 82.3% of pharmacists, 57.4% of nurses, and 38.9% of physicians; 45.7% of physicians opposed pharmacist-delivered vaccination. Pharmacists were considered a trusted source of vaccination information by 75.0% of the public, exceeding public health officials (68.3%) and exceeded only by doctors and nurses (89.2%). Public concerns about vaccination in pharmacies centered on safety (management of adverse events), record keeping (ensuring their family physician was informed), and cost (should be no more expensive than receipt at public health or physician's offices). Concerns about the logistics of vaccination delivery were expressed more frequently in regions where pharmacists were not yet immunizing than in jurisdictions with existing pharmacist vaccination programs. Conclusions: These results suggest that the expansion of pharmacists' scope of practice to include delivery of adult vaccinations is generally accepted by Canadian health care providers and the public. The acceptance of this expanded scope of pharmacist practice may contribute to improvements of vaccine coverage rates by improving vaccine access.
    No preview · Article · Jan 2016 · Human Vaccines and Immunotherapeutics
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To evaluate the safety and immunogenicity of an investigational trivalent group B streptococcal vaccine in pregnant women and antibody transfer to their newborns. METHODS: The primary outcome of this observer-blind, randomized study was to estimate placental antibody transfer rates at birth. Secondary outcomes included measurement of serotype-specific antibodies at screening, 30 days postvaccination, at delivery, and 91 days postpartum, infant antibody levels at 3 months of age, the potential effect on routine infant diphtheria vaccination at 1 month after the third infant series dose, and safety in mother and infant participants through at least 5 months postpartum. Sample size was based on 60 participants in the vaccine group giving a probability of observing at least one adverse event of 90% if the actual rate of the event was 3.8%. RESULTS: From September 2011 to October 2013, 86 pregnant women were allocated in a 3:2 ratio to receive an investigational group B streptococcal vaccine containing glycoconjugates of serotypes Ia, Ib, and III or placebo. Demographics were similar across groups. Transfer ratios were 66-79% and maternal geometric mean concentrations increased 16-, 23-, and 20-fold by delivery against serotypes Ia, Ib, and III, respectively, Women with no detectable antibodies at inclusion had lower responses than those with detectable antibodies. Three months after birth, infant antibody concentrations were 22-25% of birth levels. Antidiphtheria geometric mean concentrations were similar across groups. In the vaccine and placebo groups, 32 of 51 women (63%) and 26 of 35 women (74%) reported adverse effects, respectively. CONCLUSION: The investigational vaccine was well-tolerated without safety signals in recipients and their infants or interference with routine infant diphtheria vaccination, although further studies on safety and effectiveness are needed. The investigational vaccine was immunogenic for all serotypes, particularly among women with detectable antibody levels at baseline. Antibody transfer to neonates was at similar levels to other maternally administered polysaccharide vaccines. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01446289.
    No preview · Article · Jan 2016 · Obstetrics and Gynecology
  • Donna M MacDougall · Scott A Halperin
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Nov 2015 · Human Vaccines & Immunotherapeutics
  • Source
    [Show abstract] [Hide abstract]
    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).
    Preview · Article · Nov 2015 · Vaccine
  • Source
    Lauren Davey · Scott A. Halperin · Song F. Lee
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Nov 2015 · Journal of Bacteriology
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Oct 2015 · Vaccine
  • Lauren Davey · Alejandro Cohen · Jason LeBlanc · Scott A Halperin · Song F Lee
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Sep 2015 · Molecular Microbiology
  • Source
    [Show abstract] [Hide abstract]
    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.
    Preview · Article · Sep 2015 · Vaccine
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Sep 2015 · The Pediatric Infectious Disease Journal
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives Vaccine coverage for recommended vaccines is low among adults. The objective of this study was to assess the knowledge, attitudes, beliefs and behaviours of adults and healthcare providers related to four vaccine-preventable diseases and vaccines (diphtheria-tetanus-pertussis, zoster, pneumococcus and influenza). Design We undertook a survey and focus groups of Canadian adults and healthcare providers (doctors, nurses, pharmacists). A total of 4023 adults completed the survey and 62 participated in the focus groups; 1167 providers completed the survey and 45 participated in the focus groups. Results Only 46.3% of adults thought they were up-to-date on their vaccines; 30% did not know. In contrast, 75.6% of providers reported being up-to-date. Only 57.5% of adults thought it was important to receive all recommended vaccines (compared to 87.1–91.5% of providers). Positive attitudes towards vaccines paralleled concern about the burden of illness and confidence in the vaccines, with providers being more aware of disease burden and confident in vaccine effectiveness than the public. Between 55.0% and 59.7% of adults reported willingness to be vaccinated if recommended by their healthcare provider. However, such recommendations were variable; while 77.4% of the public reported being offered and 52.8% reported being recommended the influenza vaccine by their provider, only 10.8% were offered and 5.6% recommended pertussis vaccine. Barriers and facilitators to improved vaccine coverage in adults, such as trust-mistrust of health authorities, pharmaceutical companies and national recommendations, autonomy versus the public good and logistical issues (such as insufficient time and lack of vaccination status tracking), were identified by both the public and providers. Conclusions Despite guidelines for adult vaccination, there are substantial gaps in knowledge and attitudes and beliefs among both the public and healthcare providers that lead to low vaccine coverage. A systematic approach that involves education, elimination of barriers and establishing and improving infrastructure for adult immunisation is required.
    Full-text · Article · Sep 2015 · BMJ Open

  • No preview · Article · Aug 2015 · Canadian Medical Association Journal
  • [Show abstract] [Hide abstract]
    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. http://creativecommons.org/licenses/by-nc-nd/4.0.
    No preview · Article · Jul 2015 · The Clinical journal of pain
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · Human Vaccines & Immunotherapeutics
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jun 2015 · The Pediatric Infectious Disease Journal
  • Source
    Lauren Davey · Scott A Halperin · Song F Lee
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Apr 2015 · Journal of microbiological methods
  • Source
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Mar 2015 · Human Vaccines and Immunotherapeutics
  • Source
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Feb 2015 · Human Vaccines & Immunotherapeutics
  • Source
    [Show abstract] [Hide abstract]
    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.
    Preview · Article · Jan 2015 · Clinical Infectious Diseases
  • [Show abstract] [Hide abstract]
    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.
    No preview · Conference Paper · Dec 2014
  • Source
    [Show abstract] [Hide abstract]
    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.
    Preview · Article · Dec 2014 · Human Vaccines and Immunotherapeutics

Publication Stats

8k Citations
1,302.15 Total Impact Points

Institutions

  • 1989-2015
    • Dalhousie University
      • • Canadian Center for Vaccinology
      • • Division of Infectious Diseases
      • • Department of Pediatrics
      Halifax, Nova Scotia, Canada
  • 1997-2012
    • IWK Health Centre
      Halifax, Nova Scotia, Canada
  • 2009
    • The Ottawa Hospital
      Ottawa, Ontario, Canada
    • Stollery Children's Hospital
      Edmonton, Alberta, Canada
  • 2008
    • University of Oxford
      • Department of Paediatrics
      Oxford, ENG, United Kingdom
  • 2007
    • BC Children's Hospital
      Vancouver, British Columbia, Canada
  • 2003
    • SickKids
      • Division of Infectious Diseases
      Toronto, Ontario, Canada
  • 2000-2002
    • University of British Columbia - Vancouver
      Vancouver, British Columbia, Canada
  • 1996-2000
    • Laval University
      • Department of Pediatrics
      Quebec City, Quebec, Canada
  • 1995
    • Government of canada departments
      Ottawa, Ontario, Canada
  • 1992
    • Nova Scotia Museum
      Halifax, Nova Scotia, Canada