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This article examines the complicated terrain of immunization acceptance and access among Indigenous peoples in northern Ontario by drawing on conversations held prior to 2019 that explored knowledge about Haemophilus influenzae type a (Hia) infection specifically and attitudes toward vaccines more broadly. In the decade preceding COVID-19, Hia emerged as a leading cause of morbidity and mortality in Indigenous communities in northern Canada. Before developing new vaccines, it is imperative to hold conversations with the communities most affected and to learn more about Indigenous peoples’ perceptions of and knowledge about vaccines, both generally and Hia specifically. We conducted focus groups and one-on-one conversations with Anishinaabe Peoples in northwestern Ontario. Our findings illustrate that decisions to vaccinate are informed by a host of social, institutional, and ideological factors and historical and contemporary relationships with government institutions and health practitioners. In particular, Indigenous community members perceived their relationships with social and health services and education institutions as coercive. Thus, public health approaches cannot continue to operate in ways that prioritize interventions for Indigenous peoples and communities so that they “do the right thing.” More emphasis is needed on health service and social service provider knowledge, skills, attitudes and practices-redirecting the onus onto those within the health care system. Solutions must respect Indigenous nationhood and the right of self-determination. Finally, we suggest the term vaccine hesitancy may not entirely capture the breadth of experiences that many Indigenous Peoples and communities have and continue to have within the health care system in Canada.

Controlled human infection model (CHIM) trials are useful tools for accelerating vaccine development through the deliberate infection of healthy volunteers in a controlled environment to study the course of disease in humans. CHIM trials may pose physical, psychological, and social harms to participants. Participants are subjected to long inpatient stays and daily sample collection, which may be uncomfortable. Very little is known about the CHIM trial participant experience and decision-making process. We conducted a modified grounded theory study, embedded within the Canadian Center for Vaccinology (CCfV)'s Bordetella pertussis CHIM trial. Twenty six participants engaged in semi-structured interviews at four time periods throughout their year-long involvement in the CHIM trial, using a constant comparative approach of simultaneous data collection and analysis. This process continued until saturation was reached and an emerging theoretical model was constructed depicting the CHIM trial participant experience over time. The emergent conceptual model centered around the core category \"A Trusting Partnership\", depicting the evolution of the participant-researcher relationship throughout the experience. Establishing trust was critical during the decision-making phase, facilitated through transparent researcher-participant communication and consideration of past experiences and values. Supporting the trusting partnership during the inpatient isolation phase was facilitated through ongoing researcher-participant engagement and emotional support. During outpatient participation, maintaining the trusting partnership was achieved through effective communication, consistent follow-up care, and recognition of participants' contributions. Quality improvement (QI) recommendations were identified across all phases of CHIM trial participation. Researcher-participant trust is an integral component of the CHIM trial participant experience. QI recommendations should be taken into consideration when planning and coordinating future CHIM trials.

Immunisation during pregnancy is a relatively new strategy, and is currently limited to tetanus, pertussis, and influenza vaccines. None of these vaccines were developed specifically for use in pregnancy, but they provide an effective method of protecting mothers and young infants. In response to increases in pertussis morbidity and mortality among young infants, several countries have recommended universal tetanus, diphtheria, and acellular pertussis immunisation during pregnancy. Similarly, many countries recommend influenza immunisation during pregnancy to reduce the risk of disease for mother and infant. Although scientific evidence to support maternal immunisation against pertussis and influenza is rapidly accumulating, important knowledge gaps remain that need to be addressed by future research, which we have highlighted in this Series paper.

Five things to know about SARS-CoV-2 vaccination in pregnancy are presented. Pregnancy increases the risk of severe COVID-19, according to a recent observational study. The study found that pregnant patients with COVID-19 had a higher risk of morbidity and death. However, SARSCoV-2 vaccination was found to be protective against severe disease and death. Unvaccinated pregnant patients had a higher risk of morbidity and death compared to vaccinated individuals. Infants born to mothers with COVID-19 are also at higher risk of severe outcomes, including stillbirth and admission to the neonatal intensive care unit. A recent study during the Omicron period found increased perinatal mortality in infants born to COVID-19 patients. SARSCoV-2 vaccination during pregnancy has not been shown to increase the risk of adverse perinatal outcomes. In fact, it reduces the risk of infant hospital admission for COVID-19. All mRNA SARSCoV-2 vaccines approved for use in Canada are recommended during pregnancy, as well as for those planning to become pregnant and while breastfeeding.

Foreign-born children may face greater barriers to accessing routine immunizations in Canada or their country of birth, but provincial surveillance data on immigration status are lacking. Using our provincial immunization repository linked to administrative data, we assessed immunization coverage among immigrant and refugee children in Ontario, Canada, compared with Ontario-born children and identified factors associated with being up-to-date (UTD). We conducted a retrospective cohort study of children entering school during the 2012/13-2014/15 school years. We calculated UTD coverage for measles (2 doses), diphtheria (4 doses), and polio (3 doses) vaccines at school entry and two years after school attendance. We compared UTD coverage between immigrant/refugee children and Ontario-born children using standardized differences (SD). In a cohort of 363,662 children, 15,114 (4.2%) were immigrants/refugees (82.1% immigrants, 17.9% refugees). UTD coverage for all antigens combined was 59.2% among immigrant/refugee children compared with 87.9% among Ontario-born children at school entry (SD = 0.69), increasing to 84.9% and 94.3%, respectively, two years after school entry (SD = 0.31). Coverage was lower with greater disparities between immigrant/refugee and Ontario-born children for measles (87.9% vs. 94.8%, SD = 0.25) and diphtheria (94.6% vs. 97.4%, SD = 0.15) after two years than polio (97.1% vs. 98.4%, SD = 0.09). Among immigrant/refugee children, coverage was lowest in refugees (vs. immigrants), recent immigrants, and those born in certain regions. Immunization coverage among foreign-born children lagged behind their Ontario-born peers, even after two years of school attendance. Findings varied by vaccine, immigration category, time spent in Ontario, and country of birth.

Maternal immunisation has the potential to substantially reduce morbidity and mortality from infectious diseases after birth. The success of tetanus, influenza, and pertussis immunisation during pregnancy has led to consideration of additional maternal immunisation strategies to prevent group B streptococcus and respiratory syncytial virus infections, among others. However, many gaps in knowledge regarding the immunobiology of maternal immunisation prevent the optimal design and application of this successful public health intervention. Therefore, we did an innovative landscape analysis to identify research priorities. Key topics were delineated through review of the published literature, consultation with vaccine developers and regulatory agencies, and a collaborative workshop that gathered experts across several maternal immunisation initiatives—group B streptococcus, respiratory syncytial virus, pertussis, and influenza. Finally, a global online survey prioritised the identified knowledge gaps on the basis of expert opinion about their importance and relevance. Here we present the results of this worldwide landscape analysis and discuss the identified research gaps.

Despite higher risk of poorer outcomes and potential sub-optimal vaccine effectiveness, people living with HIV (PLWH) are underrepresented in SARS-CoV-2 vaccine trials. We evaluated the safety and immunogenicity of the Ad5-nCoV vaccine (CanSino Biologics Inc./The Beijing Institute of Biotechnology) in PLWH. In this single arm, open-label Phase 2b trial, PLWH were enrolled in Argentina. Participants received two doses of Ad5-nCoV vaccine (intramuscular, dosage 5x1010 viral particles) at days 0 and 56. The primary outcomes were safety as serious adverse events [SAE], solicited and unsolicited local and systemic adverse events, impact on HIV viral load and CD4 counts and immunogenicity measured by S-RBD IgG and pseudo-virus neutralizing antibodies (nAbs) up to 52 weeks (ClinicalTrials.gov:NCT05005156). Between June 2021-January 2022, 140 PLWH received at least one dose of Ad5-nCoV vaccine. At baseline, the majority were on antiretroviral therapy (99.3%), virologically suppressed (93.6%), with a median (IQR) CD4-cell count:736 (531-946) cells/ul. At baseline, 38 (27%) participants were seropositive for S-RBD antibodies, and 40 (28%) for nAbs. There were no SAEs related to the vaccine. Solicited AE within 7 days after first and second dose occurred in 93 (69%) and 75 (60%) participants, mostly grade 1, included pain, drowsiness and headache. The incidence of unsolicited AE within 28 days of vaccination was 10.7%. There were no significant changes in plasma viral load, CD4 count, CD4/CD8 ratio and no new AIDS-defining illnesses were reported. There were significant increases in the geometric mean titers (GMT) of S-RBD and nAbs between baseline to week 52. Seroconversion rates 28 days after the first and second doses (day 84) were 80% and 94% for S-RBD, and 35% and 78% for nAbs. The Ad5-nCoV vaccine was safe and induced an adequate immune response in virologically suppressed PLWH, maintaining high antibody titers at least during the first year post-vaccination. No significant changes were observed in plasma viral load, CD4 count and CD4/CD8 ratio.

Background During the COVID-19 pandemic, healthcare systems and healthcare workers (HCWs) faced significant demands and unique challenges. In this qualitative study, we explore the effects of the COVID-19 public health policies on British Columbia’s frontline HCWs, describe what worked in the management of the pandemic, and elucidate the lessons learned that could be applied to future pandemic preparedness, recovery and response. Methods This qualitative descriptive study is part of a larger, national multi-case study on pandemic policy communication and uptake. Semi-structured interviews were conducted from November 2020- June 2021 with fourteen HCWs working in long-term care (LTC), acute care and public health settings. Data were inductively coded, and analyzed following a resilience framework for public health emergency preparedness, which emphasizes the essential elements of a public health system, vital to all phases of health emergency management, readiness, response and recovery. Results HCWs experienced confusion, frustration, uncertainty, anxiety, fatigue and stress, during the pandemic and detailed challenges that affected policy implementation. This included communication and coordination inconsistencies between the province and regional health authorities; lack of involvement of frontline staff in pandemic planning; inadequate training and support; inadequate personal protective equipment resource capacity and mobilization; and staffing shortages. HCWs recommended increased collaboration between frontline staff and policy makers, investment in preparing and practicing pandemic plans, and the need for training in emergency management and infection prevention and control. Conclusions Pandemic planning, response and recovery should include inputs from actors/key stakeholders at the provincial, regional and local levels, to facilitate better coordination, communication and outcomes. Also, given the critical roles of frontline HCWs in policy implementation, they should be adequately supported and consideration must be given to how they interpret and act on policies. Bi-directional communication channels should be incorporated between policymakers and frontline HCWs to verify the appropriate adoption of policies, reflective learning, and to ensure policy limitations are being communicated and acted upon by policy makers.

Following carpal tunnel release (CTR), patients may be indicated for subsequent hand surgery (contralateral CTR and/or trigger finger release [TFR]). While surgeons typically take pride in patient loyalty, the rate of returning to the same hand surgeons has not been previously characterized. Patients undergoing CTR were isolated from 2010-2021 PearlDiver M151 dataset. Subsequent CTR or TFR were identified and characterized as being performed by the same or different surgeon, with patient factors associated with changing to a different surgeon determined by multivariable analyses. In total, 1,121,922 CTR patients were identified. Of these, subsequent surgery was identified for 307,385 (27.4%: CTR 289,455 [94.2%] and TFR 17,930 [5.8%]). Of the patients with a subsequent surgery, 257,027 (83.6%) returned to the same surgeon and 50,358 (16.4%) changed surgeons. Multivariable analysis found factors associated with changing surgeon (in order of decreasing odds ration [OR]) to be: TFR as the second procedure (OR 2.98), time between surgeries greater than 2-years (OR 2.30), Elixhauser-Comorbidity Index (OR 1.14 per 2-point increase), and male sex (OR 1.06), with less likely hood of changing for those with Medicare (OR 0.95 relative to commercial insurance) (p<0.001 for each). Pertinent negatives included: age, Medicaid, and having a 90-day adverse event after the index procedure. Over fifteen percent of patients who required a subsequent CTR or TFR following CTR did not return to the same surgeon. Understanding what factors lead to outmigration of patients form a practice may help direct efforts for patient retention.