A nationwide survey of past hepatitis A infections among Canadian adults.

Background: Hepatitis A virus (HAV) infection rates in Canada are low and declining. A nationwide pediatric serosurvey in 2003 confirmed that HAV infection is uncommon in children. Additional seroepidemiological data for adults would help to guide domestic use of HAV vaccines.

Antibody and immune memory persistence after vaccination of preadolescents with low doses of recombinant hepatitis B vaccine.

Little is known about the impact of low-dose hepatitis B vaccine on the persistence of anti-HBs and immune memory in school-age children. Recombivax-HB 2.5 μg (RB) has been widely used in school-age children.

Antibody kinetics among 8-10 years old respondents to hepatitis B vaccination in a low endemic country and the effect of a booster dose given 5 or 10 years later.

Few data are available concerning the persistence of anti-HBs and the effect of booster doses given several years post-vaccination against hepatitis B during preadolescence. The objective of this open-labelled clinical trial was to evaluate the persistence of antibodies after vaccination with three paediatric doses of Engerix-B at the age of 8-10 years and the effect of a booster dose given 5 (Group Y5) or 10 (Group Y10) years later. Anti-HBs were measured before and one month post-primary vaccination, then 5 and 10 years later, before the booster dose, as well as one month and 1 year post-booster.

Bats in the bedroom, bats in the belfry: reanalysis of the rationale for rabies postexposure prophylaxis.

Background: 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.

Methods: The number needed to treat after bedroom exposure to a bat was calculated as the percentage of population exposed multiplied by the inverse of crude rabies incidence. Bedroom exposure was estimated in a population survey of 14,453 households.

Cervical cancer prevention by vaccination: nurses' knowledge, attitudes and intentions.

Aim: 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.

Background: Persistent infection with human papillomavirus has been causally linked to cervical cancer. Two human papillomavirus vaccines have recently been approved for use in more than 65 countries.

The challenges facing Canadian trialists in an increasingly competitive global market: What can be done to remain competitive?

Globally, the pharmaceutical industry is condensing into fewer, larger international corporations. This has occurred with the vaccine industry in Canada, where two domestic producers have been absorbed by international companies. This changes the relationship between Canadian vaccine researchers and corporate head office research directors, who carefully assign prelicensure studies to potential market countries around the globe.

The cost of preventing rabies at any cost: post-exposure prophylaxis for occult bat contact.

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% for direct bat contact without known bite and 81% for household exposure. When bat was not available for testing, RPEP was almost always recommended.

Setting priorities for new vaccination programs by using public health officers and immunization managers opinions.

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 and 101 responded. Ninty-eight percent of respondents agreed that "recommended vaccines are very useful" (mean score=9.

Protecting the next generation: what is the role of the duration of human papillomavirus vaccine-related immunity?

Background: There is strong evidence that human papillomavirus (HPV) is necessary for the development of cervical cancer. A prophylactic HPV vaccine with high reported efficacy was approved in North America in 2006.

Methods: A mathematical model of HPV transmission dynamics was used to simulate different scenarios of natural disease outcomes and intervention strategies.

Risk and prevention of meningococcal disease among education workers: A review.

The aims of the present study were to review the risk of invasive meningococcal disease (IMD) among education workers, particularly pregnant women, and to evaluate preventive measures, in a context of endemicity, outbreak or epidemic as observed in the province of Quebec. The literature was reviewed and persons in charge of IMD surveillance in France, Quebec, the United Kingdom and the United States were interviewed. Surveys of asymptomatic carriage of Neisseria meningitidis show that transmission among students is higher than transmission between students and teachers.

Hospitalizations for diarrhea in Quebec children from 1985 to 1998: estimates of rotavirus-associated diarrhea.

Objective: To characterize the incidence and duration of hospitalization due to diarrhea and to assess the proportion of hospitalizations that are attributed to rotavirus-associated diarrhea.

Design: Retrospective study of hospitalization data.

Setting: Hospitals located in Quebec.

Cost-effectiveness analyses of hepatitis A vaccine: a systematic review to explore the effect of methodological quality on the economic attractiveness of vaccination strategies.

Hepatitis A vaccines have been available for more than a decade. Because the burden of hepatitis A virus has fallen in developed countries, the appropriate role of vaccination programmes, especially universal vaccination strategies, remains unclear. Cost-effectiveness analysis is a useful method of relating the costs of vaccination to its benefits, and may inform policy.

Human papilloma virus vaccine and cervical cancer screening acceptability among adults in Quebec, Canada.

Background: 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.

Vaccination against human papillomavirus: a baseline survey of Canadian clinicians' knowledge, attitudes and beliefs.

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%.

Trends of hepatitis A hospitalization and risk factors in Quebec, Canada, between 1990 and 2003.

Background: In Canada, targeted vaccination of at risk groups for hepatitis A (HA) is done since the mid 1990s resulting in declining incidence. This study estimated the year and age specific hospitalization rates and distribution of risk factors for HA in Quebec, Canada, between 1990 and 2003.

Methods: Records of patients hospitalized with HA-related diagnostic codes were retrieved from the provincial database.

A review of interventions triggered by hepatitis A infected food-handlers in Canada.

Background: In countries with low hepatitis A (HA) endemicity, infected food handlers are the source of most reported foodborne outbreaks. In Canada, accessible data repositories of infected food handler incidents are not available. We undertook a systematic review of such incidents to evaluate the extent of viral transmission through food contamination and the scope of post-exposure prophylaxis (PEP) interventions.

Cohort effects in dynamic models and their impact on vaccination programmes: an example from hepatitis A.

Background: Infection rates for many infectious diseases have declined over the past century. This has created a cohort effect, whereby older individuals experienced a higher infection rate in their past than younger individuals do now. As a result, age-stratified seroprevalence profiles often differ from what would be expected from constant infection rates.

Comparison of trip characteristics of children and adults with travel-acquired hepatitis A infection.

We compared the trip characteristics of 84 child and 99 adult cases with travel-acquired hepatitis A (HA). Most pediatric cases had traveled in Asia for more than 30 days and had stayed and eaten most of their meals in the homes of friends and relatives in a country where they had not been born. In contrast, the adults with travel-acquired HA had visited Latin America or the Caribbean for 14 days or less and had stayed primarily in hotels.

Canadian Association for Immunization Research and Evaluation (CAIRE) guidelines for industry-sponsored clinical trial and epidemiology contract research.

In response to concerns about interactions of academic and public health investigators with industry, the Canadian Association for Immunization Research and Evaluation (CAIRE), in collaboration with six major vaccine manufacturers, developed guidelines for participation in industry-sponsored clinical trial and epidemiology contract research within Canada. Topics addressed include definition of investigators, data ownership, protocol development, data management, data analysis, producing a study report and publication of the results of the study.

Chapter 22: Assuring the quality, safety and efficacy of HPV vaccines: the scientific basis of regulatory expectations pre- and post-licensure.

The potential of human papillomavirus (HPV) vaccines will only be realized if the vaccine candidates under development prove to be safe and effective and can be consistently produced to define quality standards. Whilst the responsibility for delivering a safe and effective product rests with the vaccine producer, a vaccine requires a license to allow it to be placed on the market. Licensure is based on an evaluation of the safety and efficacy profile of a vaccine candidate by national regulatory authorities, ideally on the basis of internationally agreed, science-based specifications and procedures.

Solicited adverse events after influenza immunization among infants, toddlers, and their household contacts.

Objectives: We assessed adverse events, including oculorespiratory syndrome, following influenza immunization during the first year of a publicly-funded program for infants, toddlers and their household members in Canada.

Methods: Parents bringing infants and toddlers for influenza immunization to clinics in Quebec or British Columbia consented to structured telephone interview 5 to 10 days later. One adult provided information for all household members.

[Portrait of the formation in vaccination training offered to Quebec nurses in the workplace].

Introduction: Nurses carry out essential functions in the area of immunization in Québec and their role has broadened considerably since January 2003, following legislative modifications. However, the training received may not always allow nurses to fill this role satisfactorily. This study seeks to document the training in immunization offered to Québec nurses in the workplace.

[Usefulness of a vaccination registry and the management of consent: the case of Quebec].

Context: The Quebec Public Health Act provides for the creation of a central vaccination registry. However, details of how such a registry would be used have not been established. This study seeks to document the opinion of both the public and of health workers about the usefulness of the registry, consent for enrolment, access to the data and the right of withdrawal.