RESEARCH THEMES
VACCINE EFFECTIVENESS
The objective of this theme is to develop and test population-based methods for the evaluation of the effectiveness of a pandemic influenza vaccine following release for general use.
SOS Network
The PCIRN Adult Serious Outcomes Surveillance (SOS) Network was established to provide infrastructure for hospital-based surveillance for flu to characterize serious outcomes (SO) of flu and for ongoing evaluation of vaccine effectiveness (VE) against SO.
The SOS Network in 2009 was comprised of 8 hospitals and ~5000 acute care beds in 5 provinces. Nurses conducted active surveillance for flu in admitted adults 10/1/09-4/30/10. All patients (pts) admitted with respiratory infection, community acquired pneumonia (CAP), exacerbation of chronic obstructive lung disease (COPD)/asthma, sepsis, or febrile cardiac disease had NP swab for flu PCR. Test-negative pts were controls for calculation of VE. Measuring vaccine effectiveness was a challenge due to the timing of the immunization campaign vs. the bulk of illness occurrence.
Sentinel surveillance for flu in the PCIRN SOS Network provides critical infrastructure to characterize clinical features and outcomes of flu in hospitalized adults. Even during a pandemic, an admitting diagnosis of flu was made in fewer than half of cases and 2/3 of cases would have been missed if presence of ILI was used to guide flu testing highlighting the importance of active surveillance for flu to better define burden of disease.
This year, the Vaccine Effectiveness group will work to leverage the infrastructure of the SOS Network, to add sites and targets. They will move to 10 active surveillance sites in 2010, and plan to accommodate an additional target with pneumococcal surveillance, measuring all cases hospitalized with CAP or IPD. There is a potential third target to be added with a proposed meningococcal study, and a proposal to conduct retrospective health care record review of hospitalizations with GBS to establish baseline incidence rates.
In Year 1, the Vaccine Effectiveness group also worked to enroll a cohort of 1440 volunteer Health Care Workers in a web-based data collection study to monitor vaccine coverage, ILI, self-collected nasal swabs and work absenteeism. The study found that adjuvanted pH1N1 vaccine was safe in these adults. However, the ability to estimate vaccine efficacy was limited because vaccine became available only after the peak of the second wave, and because the overall attack rate was low. This study has been put on hold for Year 2, but the group anticipates it will re-establish it in Year 3.
Dr. Shelly McNeil MD, FRCPC
Principal Investigator
Associate Professor of Medicine
Division of Infectious Diseases, Dalhousie University
Medical Director, Sanofi Pasteur Vaccine Challenge Unit
Canadian Center for Vaccinology
Halifax, NS
Shelly McNeil is currently an Associate Professor of Medicine and an Infectious Diseases Consultant at the QEII Health Sciences Centre in Halifax, Nova Scotia, Canada. Dr. McNeil completed her medical education at Dalhousie University followed by a three-year residency in Internal Medicine at Dalhousie and a three-year fellowship in Infectious Diseases at the University of Michigan in Ann Arbor.
Dr. McNeil returned to Dalhousie as an Assistant Professor of Medicine in 2000 and is currently cross-appointed as an Assistant Professor of Pediatrics. She is a Clinical Investigator at the Clinical Trials Research Center and the Canadian Centre for Vaccinology, Halifax where her research focuses on health policy, the evaluation of vaccine-preventable diseases in the elderly and in pregnant women and clinical trials of new vaccines targeted at adolescent and adult populations. Dr. McNeil is the Medical Director of the Sanofi Pasteur Vaccine Challenge Unit at the Canadian Center for Vaccinology, the first human vaccine challenge facility in Canada. Dr. McNeil has been awarded the Dalhousie University Faculty of Medicine Clinical Research Scholar Award for the period 2005-2010. She is Co-Chair of the Professional Education Working Group of the Canadian Immunization Committee and a member of the National Advisory Committee on Immunization (NACI), the Canadian Immunization Committee HPV Expert Working Group, and the Pandemic Vaccines Working Group of the National Pandemic Influenza Committee.
