A Randomized Controlled Trial of the Safety and Immunogenicity of Tetanus, Diphtheria, and Acellular Pertussis Vaccine Immunization During Pregnancy and Subsequent Infant Immune Response.

Background: Immunization of pregnant women with tetanus-diphtheria-acellular pertussis vaccine (Tdap) provides protection against pertussis to the newborn infant.

Methods: In a randomized, controlled, observer-blind, multicenter clinical trial, we measured the safety and immunogenicity of Tdap during pregnancy and the effect on the infant's immune response to primary vaccination at 2, 4, and 6 months and booster vaccination at 12 months of age. A total of 273 women received either Tdap or tetanus-diphtheria (Td) vaccine in the third trimester and provided information for the safety analysis and samples for the immunogenicity analyses; 261 infants provided serum for the immunogenicity analyses.

The role of healthcare provider attitudes in increasing willingness to accept seasonal influenza vaccine policy changes.

Background: This research explored the role of attitudes in acceptance of organizational change initiatives.

Methods: A survey assessed factors associated with health care provider (HCP) likelihood to accept seasonal influenza vaccine policy changes. We evaluated the impact of knowledge and individual attitudes on this outcome measure.

Impact of pharmacists as immunizers on influenza vaccination coverage in the community-setting in Nova Scotia, Canada: 2013-2015.

Background: Annual immunization is the most effective way to prevent influenza and its associated complications. However, optimal immunization rates are not being met in Nova Scotia, Canada. Additional providers, such as pharmacists, may improve access and convenience to receive vaccines.

Knowledge, attitudes, beliefs, and behaviors of pregnant women approached to participate in a Tdap maternal immunization randomized, controlled trial.

Immunization with pertussis vaccine during pregnancy is recommended in a number of countries to prevent newborn deaths from whooping cough. In some jurisdictions, vaccine uptake during pregnancy is low. We undertook a survey of the knowledge, attitudes, beliefs, and behaviors of pregnant women who had been approached to participate in a randomized, controlled trial of tetanus-diphtheria-acellular pertussis (Tdap) vaccine during pregnancy.

Impact of pharmacists as immunizers on influenza vaccination coverage in Nova Scotia, Canada.

Immunization coverage in Canada has continued to fall below national goals. The addition of pharmacists as immunizers may increase immunization coverage. This study aimed to compare estimated influenza vaccine coverage before and after pharmacists began administering publicly funded influenza immunizations in Nova Scotia, Canada.

Knowledge, attitudes, beliefs, and behaviors of parents and healthcare providers before and after implementation of a universal rotavirus vaccination program.

Objective: In Canada, rotavirus vaccine is recommended for all infants, but not all provinces/territories have publicly funded programs. We compared public and healthcare provider (HCP) knowledge, attitudes, beliefs, and behaviors 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.

Maintaining the momentum: key factors influencing acceptance of influenza vaccination among pregnant women following the H1N1 pandemic.

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.

Implementation of a universal rotavirus vaccination program: comparison of two delivery systems.

Background: Rotavirus vaccine is recommended for all infants in Canada. To evaluate the logistics of implementing a universal rotavirus vaccination program, we compared the effectiveness of program implementation in jurisdictions with either a physician-administered or public health nurse-administered program.

Methods: All infants born between October 1, 2010 and September 30, 2012 in Prince Edward Island and Nova Scotia's Capital District Health Authority were eligible for the vaccination program.

Impact of a parent-directed pamphlet about pain management during infant vaccinations on maternal knowledge and behavior.

Purpose: To evaluate the impact of a parent-directed instructional pamphlet about managing pain during infant vaccinations.

Design And Sample: New mothers hospitalized following birth of an infant at two hospitals participated in a "before-and-after" study. In the "after" phase, the pamphlet was passively inserted in discharge packages at the intervention hospital.

Influenza immunization practices and policies for health care students in Canada.

Background: Influenza vaccine is recommended for all health care providers including health care students. Little is known about how health care student programs provide information about influenza vaccination to their students, deliver vaccines and document their vaccination status.

Methods: A mixed-methods approach was used and included key informant interviews of program coordinators for health care student programs in Halifax (Nova Scotia) and a national survey of program coordinators of health care student programs across Canada.

Who knows more about immunization?: Survey of public health nurses and physicians.

Objective: To report the findings of a knowledge survey of nurse and physician immunization providers.

Design: Cross-sectional postal survey assessing demographic characteristics and vaccine knowledge.

Setting: British Columbia (BC).

Effect of respiratory hospitalization during pregnancy on infant outcomes.

The purpose of this study was to determine whether maternal hospitalization for a respiratory-related condition during influenza season results in an increased risk of neonatal morbidity. With the use of a 13-year population-based cohort study of all singleton live births in Nova Scotia (1990-2002), neonatal outcomes were compared between women with and without hospital admission for respiratory illness during influenza season at any time in pregnancy. Logistic regression analyses were performed to examine infant outcomes and to estimate relative risks and 95% confidence intervals.

THE VAXED PROJECT: an assessment of immunization education in Canadian health professional programs.

Background: Knowledge & attitudes of healthcare providers (HCP) have significant impact on frequency with which vaccines are offered & accepted but many HCP are ill equipped to make informed recommendations about vaccine merits & risks. We performed an assessment of the educational needs of trainees regarding immunization and used the information thus ascertained to develop multi-faceted, evaluable, educational tools which can be integrated into formal education curricula.

Methods: (i) A questionnaire was sent to all Canadian nursing, medical & pharmacy schools to assess immunization-related curriculum content (ii) A 77-item web-based, validated questionnaire was emailed to final-year students in medicine, nursing, & pharmacy at two universities in Nova Scotia, Canada to assess knowledge, attitudes, & behaviors reflecting current immunization curriculum.

Hepatitis A and travel amongst Nova Scotia postsecondary students: evidence for a targeted vs. universal immunization strategy.

Background: Canadian guidelines recommend hepatitis A virus (HAV) vaccination for high-risk persons, such as travelers to HAV-endemic areas. The US CDC advocates universal immunization.

Objectives: To explore whether a universal strategy for HAV immunization rather than the Canadian targeted approach for travelers is justified by measuring compliance of postsecondary students with Canadian guidelines.

Identifying attitudes, beliefs and reported practices of nurses and doctors as immunization providers.

Aim: This paper is a report of a study conducted to examine the attitudes, beliefs, behavioural intentions and self-reported behaviour of nurses and physicians relating to key immunization behaviours and compare the findings for nurses and physicians.

Background: Immunization is an important and effective public health intervention. Understanding immunization providers' attitudes and beliefs toward immunization has the potential to improve educational efforts and lead to behavioural change.

Pertussis immunization in paediatric healthcare workers: knowledge, attitudes, beliefs, and behaviour.

Healthcare workers' (HCWs) knowledge, attitudes, and beliefs regarding pertussis immunization were assessed and compared to the rate of vaccine uptake. A questionnaire was distributed to employees at a paediatric and maternity tertiary care centre. Respondents were then offered a dose of the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) at a free vaccine clinic.

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.

When is it permissible to dismiss a family who refuses vaccines? Legal, ethical and public health perspectives.

Although immunization is one of the most important health interventions of the 20th century, cases of infectious disease continue to occur. There are parents who refuse immunization for their children, creating a dilemma for the primary care physician who must consider the best interest of the individual child as well as that of the community. Some physicians, when faced with parents who refuse immunization on behalf of their children, choose to dismiss these families from their practice.

Prenatal Screening for HIV in Nova Scotia: Survey of Postpartum Women and Audit of Current Prenatal Screening Practices.

Background: Current guidelines for screening for HIV infections in Nova Scotia recommend an opt-in approach in which patients are counselled and consent to testing. The objectives of the present study were to measure adherence to these recommendations, to explore women's knowledge, attitudes, beliefs and behaviours concerning HIV screening, and to compare these results with prenatal screening practices for rubella, hepatitis B and group B streptococcus.

Methods: All women who gave birth consecutively during a seven-week period were recruited.

Influenza vaccine programs and pregnancy: new Canadian evidence for immunization.

Among healthy pregnant women, excess deaths due to influenza were documented during pandemics, but the impact of influenza on pregnant women in non-pandemic years is not clear. In Canada, influenza immunization is recommended for pregnant women only if they have comorbidities known to place them at increased risk of complications or if they deliver during influenza season, therefore becoming a contact of a high-risk infant. The National Advisory Committee on Immunization has indicated that additional evidence, relevant to healthy pregnant Canadian women, is needed to support a recommendation for influenza immunization for all pregnant women.

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.

Group B streptococcal testing during pregnancy: survey of postpartum women and audit of current prenatal screening practices.

Objective: Group B Streptococcus (GBS) can be transmitted from mother to child during delivery. At the time of the study, Nova Scotia guidelines for screening pregnant women for the presence of GBS recommended using one of two testing methods. The objective of this study was to determine the level of compliance with GBS testing recommendations and to determine women's knowledge of, attitudes towards, and beliefs about prenatal screening for this infection.