Education et formation
Addressing the vaccine confidence gap
Vaccines – often lauded as one of the greatest public health interventions – are losing public confidence. Some vaccine experts have referred to this decline in confidence as a crisis. We discuss some of the characteristics of the changing global environment that are contributing to increased public questioning of vaccines, and outline some of the specific determinants of public trust. Public decision making related to vaccine acceptance is neither driven by scientific nor economic evidence alone, but is also driven by a mix of psychological, sociocultural, and political factors, all of which need to be understood and taken into account by policy and other decision makers. Public trust in vaccines is highly variable and building trust depends on understanding perceptions of vaccines and vaccine risks, historical experiences, religious or political affiliations, and socioeconomic status. Although provision of accurate, scientifically based evidence on the risk–benefit ratios of vaccines is crucial, it is not enough to redress the gap between current levels of public confidence in vaccines and levels of trust needed to ensure adequate and sustained vaccine coverage. We call for more research not just on individual determinants of public trust, but on what mix of factors are most likely to sustain public trust. The vaccine community demands rigorous evidence on vaccine efficacy and safety and technical and operational feasibility when introducing a new vaccine, but has been negligent in demanding equally rigorous research to understand the psychological, social, and political factors that affect public trust in vaccines.
An assessment of mumps vaccine effectiveness by dose
This investigation was done to assess vaccine effectiveness of one and two doses of the measles, mumps and rubella (MMR) vaccine during an outbreak of mumps in Ontario. The level of coverage required to reach herd immunity and interrupt community transmission of mumps was also estimated.
Effectiveness of Serogroup C Meningococcal Conjugate Vaccine: A 7-Year Follow-up in Quebec, Canada
Background: A mass immunization campaign was implemented in 2001 to control a serogroup C meningococcal disease outbreak, and a newly licensed serogroup C meningococcal conjugate vaccine (C-MCV) was used. In 2002, 1 C-MCV dose was routinely offered to children 12 months of age.
Objective: To assess the epidemiologic effect of the campaign and C-MCV effectiveness during a 7-year period according to age at vaccination and delay since vaccine administration.
Methods: Cases of invasive meningococcal infection reported to public health authorities and the reference laboratory during the period 1990 to 2008 were obtained to calculate year- and age-specific incidence rates. Multiple sources were used to ascertain the immunization status of cases. Immunization registry data were used to estimate age-specific C-MCV uptake rates in different birth cohorts. Vaccine effectiveness was estimated by Mantel-Haenszelmethod and logistic regression models.
Results: After mass immunization campaign, meningococcal C disease incidence decreased markedly not only in highly vaccinated but also in poorly vaccinated and nonvaccinated birth cohorts. Overall vaccine effectiveness was 87.4% (95% CI: 75.4%-94.2%) with lower protection in children vaccinated <2 years of age and waning of protection of higher magnitude in this age group.
Conclusion: Results support the current Canadian recommendation to provide booster vaccination for adolescents.
Invasive Bacterial Infections in Relation to Influenza Outbreaks, 2006-2010
Background. We aimed to define the excess morbidity associated with bloodstream infections (BSIs), imposed by pandemic H1N1 influenza during 2009-2010 (pH1N1/2009-2010) and seasonal influenza.
Methods. Eight hospitals, accounting for 33% of hospitalizations in Israel, provided data on BSI during 20062010. The age-specific incidence of BSI due to Streptococcus pneumoniae, Staphylococcus aureus, and Streptococcus pyogenes was determined. BSI incidence rate ratios (IRRs) during seasonal and pH1N1 influenza seasons were assessed.
Conclusions. pH1N1 influenza seasons were characterized by marked increases in invasive S. aureus and S. pyogenes infections among children and adults, with the highest increase in S. pneumoniae BSI among children.
Literature Review on Rotavirus: Disease and Vaccine Characteristics
A need for a systematic literature review on the characteristics of the RV vaccine was identified. This review was commissioned by the Public Health Agency of Canada. The purpose of this document is to apply the Erickson, De Wals and Farand framework on immunization programs to review the disease burden attributed to RV and the vaccine characteristics of Rotateq.
Mise à jour sur le succès du vaccin conjugué contre le pneumocoque
Quelques années après l’adoption du vaccin conjugué heptavalent contre le pneumocoque (PCV7) au Canada et ailleurs, la vaccination systématique des nourrissons a suscité la quasi-éradication des pneumococcies invasives causées par les souches des sérotypes vaccinaux, tant chez les enfants que chez les adultes. On a également observé une diminution importante des maladies liées au pneumocoque, y compris la pneumonie lobaire et l’otite moyenne. Ces diminutions ont été contrebalancées, dans une certaine mesure, par l’augmentation des maladies à sérotypes non vaccinaux. Le sérotype 19A, qui est souvent hautement résistant aux antibiotiques, prédomine désormais. Dans la plupart des populations, cependant, la magnitude d’une maladie de remplacement est beaucoup plus faible que celle de la diminution des pneumococcies invasives attribuables au vaccin PCV7. De plus en plus de données probantes indiquent que trois doses du vaccin PCV7 assurent une protection presque identique à celle conférée par quatre doses. Les nouveaux vaccins conjugués 10-valent et 13-valent contre le pneumocoque ont récemment été approuvés au Canada. Ces vaccins accroissent la couverture des sérotypes pneumococciques, y compris le sérotype 19A (présent dans le vaccin 13-valent). De nombreuses provinces et de nombreux territoires ont intégré le vaccin 13-valent à leur programme de vaccination.
Recension des écrits sur le rotavirus : Caractéristiques de l'infection et du vaccin
Certains ont fait valoir la nécessité de procéder à une recension systématique des écrits sur les caractéristiques du vaccin antirotavirus. Cette recension a été commandée par l’Agence de la santé publique du Canada (ASPC). Dans le présent document, nous nous servirons du cadre élaboré par Erickson, De Wals et Farand(4) aux fins des programmes de vaccination pour atteindre un double objectif : étudier le fardeau de la maladie attribuée au rotavirus (RV), et examiner les caractéristiques du vaccin RotateqMC.
Survey of Parents on Key Issues Related to Immunization: Executive Summary
Quantitative research was conducted with Canadian parents in order to understand their perceptions and information needs related to childhood immunizations. Telephone interviews were conducted with a random sample of 1,745 Canadian parents, screening for those who had at least one child under the age of 18. Interview questions investigated Canadian parents' knowledge, awareness, attitudes and behaviours related to immunization. Findings from this research will be used to inform public education strategies and initiatives.
Update on herpes zoster vaccination: A family practitioner's guide
The objective of this Update is to answer frequently asked questions surrounding the use of the herpes zoster (shingles) vaccine.
Update on the success of the pneumococcal conjugate vaccine
Several years after the seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in Canada and elsewhere, routine infant vaccination has led to near eradication of invasive pneumococcal disease caused by vaccine serotype strains in both children and adults. There have also been significant declines in pneumococcal- related disease including lobar pneumonia and otitis media. These declines have been offset, to some extent, by increases in nonvaccine serotype disease. Serotype 19A, which is often highly resistant to antibiotics, has become predominant. In most populations, however, the magnitude of replacement disease is much lower than the magnitude of decline in invasive pneumococcal disease with the use of PCV7. There is increasing evidence that three PCV7 doses provide protection that is nearly identical to that of four doses. New 10-valent and 13-valent pneumococcal conjugate vaccines were recently approved in Canada. These vaccines increase pneumococcal serotype coverage including serotype 19A (present in the 13-valent vaccine). Many provinces and territories have incorporated the 13-valent vaccine in their vaccination programs.