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Background

• The CIC is a biennial conference organized by the CPHA.
• At the 2024 CIC meeting:
• There were 830 participants from across Canada.
• Participants included academics, epidemiologists, government representatives, nurses, physicians, and students.
• There were a total of 190 presentations, with 140 posters and 150 oral presentations.

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Objectives of the CIC:

• Utilize effective evidence-based programs and best clinical practices, as well as policy approaches.
• Describe vaccine-related research and identify colleagues and partners to develop initiatives.
• Identify vaccination-related challenges and solutions, trends, emerging issues and evidence gaps.

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Steering Committee

Dr. Ajit Johal

Dr. Johal a clinical assistant professor for the University of British Columbia Faculty of Sciences program. He has been providing immunizations and clinical education since 2012. As a community pharmacist, he is an accessible provider of immunizations to patients in the community.

Dr. Dominique Tessier

Dr. Tessier, Medical Director of the Groupe Santé Voyage clinics, is well known in the field of immunization and travel medicine. She is also a clinician at the Centre hospitalier de l'Université de Montréal (CHUM).

Dr. Zain Chagla

Dr. Chagla is an infectious disease specialist. He has given media interviews on the COVID-19 pandemic and published several op-eds on testing, disease elimination, and public health interventions.

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Presentation Summaries

Vaccine Hesitancy

The value of adult vaccines and potential benefits of increased uptake in Canada

A Vaccine Confidence Toolkit to support healthcare providers with vaccine conversations

Building Vaccine Confidence and Demand in a Digital Information Age: An eLearning Series Update

COVID-19

Participant-reported neurological events following immunization in the CANVAS-COVID Study

Differential antibody profile and neutralization antibody titers (long-term COVID-19)

Safety and immunogenicity: SARS-CoV-2 spike receptor-binding and N-terminal domain COVID-19 vaccine

Respiratory syncytial virus (RSV)

RSV vaccine safety and coverage in Ontario: 2023-2024

Neighbourhood-level burden of social risk factors on respiratory syncytial virus hospitalization

Assessing the impact of pharmacist-initiated vaccination against RSV in older adults

Coadministration of a RSV vaccine with an influenza or mRNA SARS-CoV-2 vaccine in older adults

High-Risk Populations

Canadian COVID-19 vaccine coverage among key vulnerable and hard-to-reach populations

Strategies to increase vaccine uptake: people experiencing homelessness, drug use, mental illness

An overview of immunization against SARS-CoV-2 in patients with hematologic malignancies

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Vaccine Hesitancy

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The value of adult vaccines and potential benefits of increased uptake in Canada

Jia Hu^1,2, Madison M. Fullerton¹, Theresa Tan¹, et al.

1. 19 to Zero Inc., Calgary, Alberta, Canada; 2. Adult Vaccine Alliance, Calgary, Albert, Canada.

Developed by IMPACT Medicom Inc 2024

Background

• Despite the efficacy of vaccination programs, vaccination rates for several adult and childhood vaccines were below targets set for 2025 as part of the National Immunization Strategy.
• This study aimed to better understand the value of adult vaccines in Canada by:
• Estimating the current value of adult vaccines to the Canadian healthcare system and to the national economy
• Evaluating the value of increased vaccination in adults
• Assessing the overall value of adult vaccines in Canada

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The 6 key selected adult vaccines for the study:

• Recombinant zoster Vaccine (RZV)
• Respiratory syncytial virus vaccine (RSV)
• Pneumococcal conjugate vaccine (PCV)
• Human papillomavirus vaccine (HPV)
• COVID-19 vaccines
• Influenza vaccines

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Value

Adult vaccines generate approximately $514 million in savings for the healthcare system, $410 million of which are from averted hospitalization costs.

It is estimated that the six studied adult vaccines add $1.9 billion dollars in productivity benefits annually to the Canadian economy

Increased uptake in adult vaccinations in Canada is anticipated to lead to greater value for the collective healthcare system and the Canadian economy.

The estimated value, annually, of adult vaccines to the healthcare system and the economy.

The value of vaccines in averted healthcare costs and in productivity gains is roughly 3 times every dollar invested in vaccination programs.

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🍁 Canadian Perspective

• The quantification of the benefits of adult vaccination in terms of economics, as well as the tangible benefits for the healthcare system are valuable information for healthcare practitioners.  
• Seeing the true benefits to the healthcare systems helps to motivate healthcare providers to be more engaged in vaccination programs and could encourage them to take a more active role in education programs.
• Healthcare providers may also be motivated by this data to push for the inclusion of vaccinations in funding and benefits plans.  
• In weighing the various healthcare costs, we know there is a limited budget to work from, so these numbers can help to leverage the focus on vaccinations when making decisions about which healthcare areas to focus on.  

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A Vaccine Confidence Toolkit to support healthcare providers with vaccine conversations

Alyssa Lip¹, Cora Constantinescu^1,2, Sherilyn K.D. Houle³, et al.

1. Alberta Health Services, Alberta; 2. University of Calgary, Alberta; 3. University of Waterloo, Waterloo, Ontario

Developed by IMPACT Medicom Inc 2024

Background

• Multidisciplinary resources are needed to go beyond traditional information dissemination, incorporating trust-building and behavioural change strategies to help healthcare practitioners (HCPs) navigate complex vaccine conversations.
• This study aimed to:
• Develop a multidisciplinary toolkit to equip HCPs with practical, evidence-based tools for effective vaccine conversations
• Ensure the toolkit resources are accessible and user friendly to help HCPs support informed patient decision-making
• Leverage behaviour-change techniques to enhance patient-HCP interactions during vaccine conversations
• Continuously gather user feedback to assess and improve the toolkit to meet diverse HCP needs

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Toolkit Components

Virtual Simulation Games: �Realistic simulations of vaccine counselling conversations with patients

PrOTCT Vaccine Conversation Framework: �Motivational interviewing technique framework to support effective vaccine conversations

Printable Vaccine Action Plans: �A tool designed to empower patients to take action on their vaccination decisions

Common Vaccine Q/A’s: �Vaccine science information for both HCPs and patients

Patient-Centred Assessment Tools: Assessment tool to measure the effectiveness of HCP vaccine conversations and to identify opportunities for improvement

�Additional Resources: �Links to other resources for HCPs

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Evaluation and Feedback

Quantitative Evaluation�HCPs who practiced patient conversations with the Virtual Simulation Games demonstrated significant improvement in self-confidence and self-efficacy when engaging with vaccine-hesitant patients.

Interactive Conference Workshop�Workshop participants (28 HCPs) identified the Vaccine Confidence Toolkit as a valuable resource for enhancing their vaccine-related conversations with patients.

Social Media�In its first month of publication, the toolkit garnered significant attention on social media, achieving 452 impressions.

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Looking to the Future

Patient-centred evaluation tools will be used to continuously assess the clinical impact of the Vaccine Toolkit and to inform ongoing improvements with the ultimate goal of encouraging broader uptake of these vaccine-conversation tools.

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🍁 Canadian Perspective

• The toolkit is useful and contains some unique elements.
• The simulation modules are valuable tools for healthcare providers to practice their patient counselling techniques around vaccination.
• The action plan is a practical element of the toolkit, as patients often want something tangible to focus on that is a more formalized way of providing accountability.  
• The multiple components of the toolkit give busy healthcare practitioners the flexibility to take just the pieces that are relevant or useful for them and come back to review other components when they need them in the future.

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Building Vaccine Confidence and Demand in a Digital Information Age: An eLearning Series Update

Greg Penney¹, Antonella Pucci¹, Laura Bouchard¹, Renata E Mares²

1. Canadian Public Health Association and CANVax, Ottawa, Ontario, Canada; 2. Adaptable Folks, Mississauga, Ontario, Canada

Developed by IMPACT Medicom Inc 2024

Background

• An eLearning series was developed to introduce infodemic management competencies and help rebuild vaccine confidence in Canada.
• The series presents healthcare and non-healthcare providers with evidence-based innovations and practical applications to improve immunization programming and deliver trusted, effective services.
• This report evaluated participation in the course and gathered feedback on knowledge and competence both pre- and post-learning.

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4 Key Modules

Module 1: Listen�Leverage social listening to understand the questions, concerns, and misinformation surrounding vaccines and vaccination programs.

Module 2: Inform�Deliver accurate, high-quality vaccine information and programming.

Module 3: Intervene-Counter-Monitor�Apply methods and tools to drive intervention through thoughtful design, implementation, and evaluation.

Module 4: Support�Support and promote healthy behaviours, community engagement, and resilience.

Additional Resources

• OpenWHO: Infodemic Management Channel (courses)
• Managing Infodemics in the 21st century (book)
• Infectious Disease Emergencies - Chapter 34 - Infodemics and Information Management (book)
• EMMIE program in Quebec (motivational interviewing)
• JITSUVAX.info(opens in a new tab)
• WHO/UNICEF Infodemic Insight Report in Six Steps
• Understanding community information needs through stories
• CDC Rapid community assessment

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Course Enrolment and Completion (as of April 2023)

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Measurement

Learner Feedback

1 is not at all knowledgeable and 5 is extremely knowledgeable; 1 is not at all confident and 5 is extremely confident; 1 is not at all important and 5 is extremely important

The extent to which learners anticipate this online course will inform their vaccine programming issues

The roles of learners when they participated in the course. (Learners selected all that apply)

Measure on Scale 1–5: Presenting 4 and 5

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Next Steps

The following questions need to be explored more in depth to inform updates and improvements to the course:

• Overall, was this course a productive use of your time?
• How will you use the information you've learned in this online course?
• Has this online course changed your attitudes towards building vaccine confidence and demand?
• What did you like most about this online course?
• What suggestions do you have to improve on this online course?

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🍁 Canadian Perspective

• The e-learning program provides valuable information on tackling misinformation and is a useful resource for healthcare practitioners who have to tackle this difficult topic with their patients.
• There is a need to improve the evaluation of these programs in terms of the numbers of people completing them, as well as knowledge gained and their overall impact in terms of vaccination rates. However, this is a good step in the right direction in terms of attempting to evaluate the impact of an e-learning program.
• Overall, these educational toolkits and programs, as well as the quantification of costs averted to the healthcare system are useful to aid healthcare practitioners in reducing vaccine hesitancy.

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COVID-19

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Participant-reported neurological events following immunization in the CANVAS-COVID Study

Karina A. Top¹, Hennady P. Shulha², Matthew P. Muller³, et al.

1. Canadian Center for Vaccinology, IWK Health, Halifax, NS; 2. Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC; 3. Department of Medicine, Unity Health Toronto, Toronto, ON

Developed by IMPACT Medicom Inc 2024

Background

Introduction

• Monitoring COVID-19 vaccines through post-market surveillance is crucial for identifying rare adverse events, such as neurological symptoms after vaccination, that might not emerge during clinical trials.
• In the CANVAS-COVID study over 1.8 million Canadians of all ages were actively monitored for severe health events that occurred within the 7 days following each dose of COVID-19 vaccine.

Methods

• Participants received an online survey to document any health incidents that hindered daily activities or necessitated medical care within 7 days following their COVID-19 vaccination or 7 days prior to the survey.
• Neurological events were defined as health events where the most severe symptom reported was one or more of: numbness/tingling, loss of taste or smell, loss of vision, weakness/paralysis of face, arms, or legs, seizure, confusion, change in personality or behaviour, difficulty urinating or defecating.
• Data were collected in the CANVAS-COVID database and extracted for analysis

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Results

Neurological events per 10,000 participants among vaccinated participants and unvaccinated controls by vaccine product and dose

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Results

• A greater proportion of females reported neurological events across all groups when compared to males.
• Participants who reported neurological events were more likely to also report fair to poor baseline health status prior to vaccination (versus those without neurological events).

Numbness/Tingling

Loss of Smell/Taste

Neurological Events

Multivariable logistic regression adjust for age, sex, previous SARS-CoV-2 infection and baseline health status

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Discussion

Limitations

• As the survey involved patient-reported outcomes, medical records were not available to confirm diagnosis, investigations, or treatment given. Standard case definitions could not be applied.

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Conclusions

• Survey findings affirm the safety of COVID-19 mRNA vaccines and confirm the reported associations between ChAdOx1 dose 1 and neurological events.
• Patient-reported outcomes surveys are a useful tool for post-market surveillance programs.

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🍁 Canadian Perspective

• The CANVAS-COVID study presents patient-based active surveillance results in a post-market study, which is very important real-world data. It is important that healthcare providers and patients are aware of that this type of data is collected in large numbers, as it increases trust.
• The safety data was very reassuring and adds to the confidence of healthcare providers and patients as to the safety of the vaccines. It is especially reassuring to see that rare side effects, such as lung-related events, are being looked at in large numbers of patients and that these events are shown to be very rare.
• The reported loss of smell was a strange finding but could have been a result of high rates of COVID-19 at the time.

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Differential antibody profile and neutralization antibody titers (long-term COVID-19)

Rachelle Buchanan¹, Ethan B. Jansen^1,2, Una Goncin³, et al.

1. Vaccine and Infectious Disease Organization, University of Saskatchewan; 2. Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan; 3. Department of Anesthesiology, University of Saskatchewan.

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Background

• The World Health Organization (WHO) defines Long COVID or Post-Acute Sequelae of COVID-19 (PASC) as symptoms that last beyond 12 weeks of acute COVID-19 onset.
• As many as 65 million people may be impacted by these ongoing symptoms.
• Currently, no approved diagnostics or treatments for PASC are available. There is a clear need to better understand the mechanisms of PASC.
• This study examines the immune profiles of PASC and the role that antibodies and cytokines play in the disease.

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Results - Cohort demographics and clinical characteristics�

No COVID

Acute COVID-19 (<4 weeks)

Acute Recovery (4–12 weeks)

Recovered (12+ weeks)

PASC (12+ weeks)

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Results - IgG antibody binding to SARS-CoV-2 proteins associated with recovery group

Titers of IgG antibodies binding to SARS-CoV-2 Spike protein S1 domain (S1) and receptor binding domain (RBD) are lower in participants with PASC.

Individuals with PASC have lower neutralizing antibody titers againts SARS-CoV-2 ancestral virus and Omicron variant compared to recovered and acute recovery participants.

Lines represent the geometric mean titer. *p<0.05, **p<0.01, *** p<0.001, ****p<0.0001 for comparison of recovery groups by Mann-Whitney test.

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Conclusions

• Study participants with PASC reported more pre-existing conditions than recovered participants.
• Binding and neutralizing titers decreased over time in male participants whereas titers in female participants remained stable.
• In comparing individuals with 3x COVID-19 vaccinations, those with PASC had lower binding and neutralizing antibodies titers compared to those in the recovered group. These differences were equalized for participants with 4 COVID vaccinations.

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🍁 Canadian Perspective

• The Buchanan, et al. study on people with long-term COVID-19 symptoms is interesting, as it shows there are some phenotypic characteristics of people who tend to suffer from long-term symptoms.
• It is hard to gage whether these characteristics that are correlated with long-term symptoms are cause or effect in these types of studies. However, it highlights the importance of increasing the focus of vaccination programs on people who are in congregated living spaces, with underlying comorbidities, and with other characteristics that can make them at higher risk of long-term symptoms.

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Safety and immunogenicity: SARS-CoV-2 spike receptor-binding and N-terminal domain COVID-19 vaccine

Spyros Chalkias¹, Patrick Dennis², Dena Petersen³ et al.

1. Moderna, Inc, Cambridge, MAS, USA; 2. DelRicht Research, New Orleans, LA, USA; 3. Noble Clinical Research, Tucson, AZ, USA

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Background

• mRNA-based vaccines protect against COVID-19.
• The first mRNA vaccine, mRNA-1273, encodes for the full-length SARS-CoV-2 spike protein.
• This study compares the investigational vaccine, mRNA-1283, with mRNA-1273 for immunogenicity and safety.
• mRNA-1283 encodes the immuno-dominant receptor-binding domain (RBD) and N-terminal domain (NTD) of the spike protein.
• Has the potential for improved thermostability (shorter mRNA).

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Objectives

• The primary objective was to assess non-inferior neutralizing antibody responses, non-inferior relative vaccine efficacy, and safety and reactogenicity of mRNA-1283.222 (10μg) vs mRNA-1273.222 (50μg).
• Median follow-up for interim safety and immunogenicity is 3.25 months

Methods

• 11,464 individuals, aged ≥12 years were randomized 1:1 and stratified by age group �(12 to<18, 18 to <65, and ≥65).

Participants were not excluded for prior COVID-19 vaccination or SARS-CoV-2 infection unless it occurred in the 90 days prior to enrollment.

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Results - Neutralizing Antibody Responses

Responses against Omicron BA.4/BA.5 were higher with mRNA-1283.222 than with mRNA-1273.222.

Success Criteria Met

GMR noninferiority: Lower 955 of GMR was >0.667

SRR difference noninferiority: Lower 95% of CI of SRR difference was >-10%

Neutralizing antibody responses against ancestral SARS-CoV-2 were higher with mRNA-1283.22 than with mRNA-1273.222.

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Safety

• The frequency of local adverse reactions was 70.3% for mRNA-1283.222 and 78.4% for mRNA-1273.222.
• The most frequently observed local adverse reaction was pain at the injection site (68.5% and 77.4% in the mRNA-1283.222 and mRNA-1273.222 groups, respectively.)
• The frequency of systemic adverse reactions was 64.4% for mRNA-1283.222 and 64.2% for mRNA-1273.222.
• Fatigue (50.4%, 49.0%), headache (44.1%, 41.2%), and myalgia (38.2%, 37.0%) were the most frequently observed systemic adverse reactions in the mRNA-1283.222 versus mRNA-1273.222 groups, respectively.

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Conclusions

• The primary immunogenicity objective was met:
• mRNA-1283.222 elicited higher neutralizing antibody responses when compared with mRNA-1273.222.
• The higher neutralizing antibody responses with mRNA-1283.222 were consistent across all age groups, with the highest geometric mean ratio (GMR) observed in the ≥65 age group.
• Reactogenicity of mRNA-1283.222 was similar to that of mRNA-1273.222 (local and systemic).
• The safety profiles of mRNA-1283.222 and mRNA-1273.222 were similar.

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🍁 Canadian Perspective

• The Chalkias, et al. study comparing the efficacy and safety of the novel mRNA-1283 vaccine versus the original mRNA-1273 vaccine is interesting, as there has always been a question as to whether being exposed to more of the virus would improve vaccine efficacy.
• It is reassuring to see that the adverse events are similar between the two vaccines, even in the more elderly patients. The geometric mean concentrations of antibodies were similar between the two vaccines, but it is interesting that there was a much lower dose used of the mRNA-1283 vaccine.
• The examination of the mRNA-1283 vaccine is important, because it will be the COVID-19 portion of the combined influenza vaccine produce by Moderna. So, it is reassuring to see that has a similar safety profile as the original COVID-19 vaccine.

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Respiratory Syncytial Virus (RSV)

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Respiratory syncytial virus (RSV) vaccine safety and coverage in Ontario: 2023-2024

Chi Yon Seo¹, Gillian Lim¹, Tara Harris¹, Reed Morrison^1,2, Sarah Wilson^1,3

1. Public Health Ontario, ON; 2. NOSM University, ON; 3. University of Toronto, ON

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Background

• August 2023: Health Canada approved AREXVY (RSVPreF3), a RSV vaccine for adults ≥60 years of age.
• Fall 2023: Ontario introduced a publicly-funded RSV vaccination program targeting adults ≥60 years old living in long-term care homes and other similar settings for seniors. Ineligible adults could purchase the vaccine.
• This study aimed to assess RSV vaccine uptake in Ontario long-term care homes in the 2023-24 RSV vaccination program.
• Passive surveillance was utilised to assess reports of adverse events subsequent to RSV vaccination.

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Methods

RSV Vaccine Coverage

RSV vaccination among residents was collected via an online survey of long-term care homes (LTCHs).

RSV Vaccine Safety

Adverse events following immunization (AEFIs) were reported by healthcare providers and vaccine recipients (and/or their caregivers) to the local public health units through the provincial surveillance system (CCM/iPHIS).

Doses used for reporting calculation:

• Publicly-funded doses distributed up to March 31, 2024 from the Ministry of Health.
• Private doses distributed up to April 30, 2024 from GSK

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Results – Vaccine Coverage

• RSV vaccination rates declined with increased number of residents per facility.
• Vaccine coverage among survey respondents living in LTCHs was 58.5% for RSV compared with 85.4% for influenza.

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• Survey response rate was 64.4% (401/626 LTCHs)
• The median number of residents per facility was 112 (Range: 11–468)

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Adapted from Seo, et al. poster presentation (CIC 2024)

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Vaccine Safety

The early evaluation of the AREXVY vaccine's safety aligns with its established safety profile.

Adverse events following immunization

Note: an AEFI report may contain multiple adverse events (AEs). Thus the sum of all AE-specific counts may not equal the total number of AEFI reports.�*Other severe or unusual event includes events that do not meet pre-defined provincial event definitions but are considered clinically important or epidemiologically relevant.

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Vaccine Safety - Severe or unusual adverse events

• The most frequently reported AE was pain/redness/swelling at the injection site.
• 73.7 % were female; median age 75 years (range 34–99) with 97% in adults ≥60 years of age.
• There were 4 reports of a serious AEFI (0.002% of all doses distributed). These occurred in adult ≥75 years of age.
• 2 reports of Guillain-Barré Syndrome (GBS), 1 of Bell's palsy, 1 of arrhythmia.
• One GBS report met Brighton Scoring level IV.
• One GBS report occurred subsequent to AREXVY co-administration with Pneu-C-20 (further information is being collected for Brighton level scoring).

• 21.1% reported vaccination location as long-term care or retirement home.
• 38 AEFIs were reported; 37 subsequent to AREXVY vaccine alone and 1 subsequent to AREXVY �co-administration with Pneu-C-20 vaccine.
• Overall AEFI reporting rate was 176.6 per 100,000 doses distributed (publicly-funded and private purchase doses).

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Considerations, Challenges and Facilitators

• Timing and prioritization of multiple vaccines.
• Consent for 3 vaccines and medical directives.
• Education on new vaccines and expanding products.
• Staff turnover.

• Vaccine hesitancy and fatigue.
• Outbreaks in settings.
• Coordinating setting, engaging with partners, targeting resources and supporting materials.

• Simplified consent forms and vaccination plans.
• Support from resident and family counsellors.
• Education of residents and family.
• Support from public health and medical leads in setting

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Lessons Learned and Limitations

Logistics

• Benefits of direct delivery, earlier delivery and program start
• New program rollout and confusion around timing
• Packaging limitations

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Knowledge Transfer

• Early and often
• Tailored to various setting needs
• Standardized and consistent messaging

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Conclusions

• RSV vaccination varied according to LTCH size.
• Influenza vaccination was higher compared to RSV coverage. Further investigation is needed to understand the difference in coverage between the two vaccines among LTCHs.
• RSV reporting rate of AEFIs is lower than or similar to that of other vaccines commonly administered to older adults (2022 Ontario data).
• The early evaluation of the AREXVY vaccine's safety aligns with its established safety profile.

• Absence of doses administered was a limiting factor for the reporting rate calculation.
• Low numbers of AEFIs were reported in the first season of the vaccination program. Continued monitoring will be essential to garner a realistic view.
• Next step: Analysis of expected rates of GBS vs observed rates of GBS.

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🍁 Canadian Perspective

• It was surprising to see that the coverage of RSV vaccination in long-term care homes was so low in such a static population, where health-care providers are bringing the vaccine directly to patients.
• It is clear there was some hesitancy in giving the RSV vaccine.
• It is possible that the hesitancy was around co-administration of the two vaccines, as there was some guidance to avoid co-administration at the time.
• Other reasons for hesitancy might have been the lack of familiarity with the RSV vaccine and potentially frailer patients not wanting to be exposed to a new vaccine.
• Also, there was a bad COVID-19 outbreak last year, which may have affected RSV vaccination rates.
• Given the RSV publicly funded program was new to Ontario, the lack of familiarity might have also contributed to the hesitancy.

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🍁 Canadian Perspective (cont’d)

• There is some concern with the methodology used.
• It was survey based instead of a vaccine tracking system, so it is possible that the number of vaccines given was overestimated due to provider overreporting.
• Also, the study included only two thirds of long-term care homes, so it is also possible that those not included were less likely to give the vaccines.
• Having some auxiliary immunization support, such as a clinical pharmacist attending rounds and delivering the vaccine could aid in uptake.
• There could be discussions during rounds to let the residents and caretakers know that the RSV program would become part of the action plan.
• Vaccine registries are important for keeping track of vaccine uptake, as well as knowledge translation and education for newer vaccination programs.
• Having these pieces in place are important to effectively track doses given and improve transparency on vaccine usage and wastage and the impact of various initiatives to improve uptake.  

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Neighbourhood-level burden of social risk factors on respiratory syncytial virus hospitalization

Kitty Y.A. Chen^1,2, Trevor van Ingen¹, Brendan T. Smith^1,2, et al.

1. Public Health Ontario, ON; 2. University of Toronto, ON

Developed by IMPACT Medicom Inc 2024

Background and Objectives

• As a leading cause of lower respiratory tract infections in young, old, and immunocompromised individuals, RSV is a burden on the healthcare system.
• There is limited understanding regarding how social factors affect the burden of RSV.
• Better understanding the impact of social determinants is vital for informing RSV vaccination programs in Canada.
• This study focuses on neighbourhood-level social factors to provide population-based estimates of RSV hospitalization rates in Ontario..

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Methods

Outcome

• RSV-related hospitalizations (validated algorithm based on ICD-10-CA codes).
• 1 admission per season (defined as Sept 1st through August 1st).

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Exposures

• Neighbourhood-level social risk factors: individuals were assigned to a quintile based on their neighbourhood of residence.
• Marginalization (Q1 = least marginalized): racialized, material resources (poverty), dwelling (ownership etc.,) age/labour force participation.
• Housing (Q1 = fewest): multigenerational families, unsuitable housing (crowding), dwelling size, households with persons under 5 years.

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Analysis

• Crude and age-standardized annualized incidence rates of hospitalization (95% CI) calculated using 2016 Canadian Census.

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Results

• The annual age-standardized RSV hospitalization rate was 27 cases per 100,000.
• The highest annual incidence of RSV hospitalization was in children <2 years of age and in adults ≥85 years of age.
• The rates of RSV hospitalization increased over time with the highest rates occurring in winter.

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Results

Q1 = fewest�Multigenerational families, unsuitable housing (crowding), dwelling size, households with persons under 5 years.

Q1 = least marginalized�Racialized, material resources (poverty), dwelling (ownership etc.,) age/labour force participation.

Marginalization

Housing

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Discussion

• RSV burden is impacted by social factors and is greatest in young children and in older adults.
• Study Strengths: population-based approach, not limited to pediatric/older populations, explored many social risk factors.
• Study Limitations: Potential underestimation, confounding of results by comorbidities, immunity, etc. Study was restricted to severe outcomes.
• Study findings may inform the future design of RSV vaccination programs to reduce inequities. Study can also serve as a baseline to measure the impact of immunization program improvements.

Conclusion

• Neighbourhood conditions such as marginalization and housing impact the burden of RSV hospitalization in Ontario, Canada.

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🍁 Canadian Perspective

• The Chen, et al. poster on the factors affecting the risk of RSV hospitalization tells us those patients who you really want to focus on in increasing vaccine uptake. If you have someone who is in an unstable living situation and living month-to-month, you may want to focus more on them then a lower risk individual.
• It is important to have conversations and build trust with those high-risk patients, even if the vaccine is not covered, as it is also a way to increase public pressure to fund these programs. Also, these are the people who you want to come in to get vaccinated as soon as there are programs in place.
• Targeted education to those at high-risk is important and needs to consider factors that improve trust, such as educators being people from the community who can build relationships. Family doctors are often trusted members of the community and can really help in education.

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Assessing the impact of pharmacist-initiated vaccination against RSV in older adults

Ajit Johal¹

1. University of British Columbia, BC, Canada

Developed by IMPACT Medicom Inc 2024

Background

This study evaluates the distributions of physicians and pharmacists who initiated the uptake of recently approved RSV vaccines in older patients in British Columbia.

Methods

In British Columbia, pharmacists are authorized to administer recommended vaccines as Schedule 2 products, without requiring a prescription from a physician.

Pilot

• A pilot study was conducted to assess the effect of independent pharmacist-led vaccine assessment and administration on RSV vaccination rates in older adults.
• Three community pharmacy locations in Vancouver, BC, participated in the study.
• The number of RSV vaccinations initiated by the pharmacist were compared to the number prescribed by a medical doctor during a 6-month period from September 15^th, 2023 through March 31st, 2024. (Pharmacy claims data for RSV vaccine dispensing and administration were evaluated)

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Results

• Across the 3 community pharmacy locations, a total of 236 individuals were vaccinated for RSV with the recombinant, AS01E adjuvanted vaccine.
• 199 vaccinations were initiated by pharmacists and 37 by physicians.

Recommendations

• The pilot case study findings highlight the positive impact pharmacists can have on RSV vaccination uptake in eligible individuals.
• Based on the study findings, we recommend further exploration of the impact pharmacists can have on vaccine uptake in older adults (where pharmacists have the scope to independently assess and administer vaccinations).

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🍁 Canadian Perspective

• The Johal, et al. poster examines the role of pharmacists in aiding to deliver vaccines and shows a huge number of pharmacists were able to independently vaccinate older adult patients against RSV versus physicians in this study population. It would be interesting to see if this difference can be seen in a larger area where pharmacists may be less motivated to do this.
• The pharmacist driven vaccinations greatly improve access to vaccines and people are able to go to places that are familiar to them and comfortable, which can aid in reducing hesitancy. The program also allowed partners to be vaccinated without needing a prescription. Vaccines are also an area that allow direct-to-consumer ads, so this can be a valuable tool to improve uptake.

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Coadministration of a RSV vaccine with an influenza or mRNA SARS-CoV-2 vaccine in older adults

Jaya Goswami¹, Jose Cardona¹, Alana K. Simorellis¹, et al.

1. Moderna Inc.

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Background

• Coadministration of vaccines can improve uptake and reduce healthcare burden.
• This phase 3 study investigated the safety and immunogenicity of RSV vaccine mRNA-1345 when coadministered with SD SIIV4 or Moderna bivalent COVID-19 vaccine in adults ≥50 years old.

Methods

Patients were stratified by age group: 50–59 years, 60–74 years, and ≥75 years.

• PART A: mRNA-1345 coadministered with SD-SIIV4.
• PART B: mRNA-1345 coadministered with Moderna Bivalent COVID-19 vaccine.

​

Data cut-off for Part A was March 8, 2023 and Part B was June 21, 2023.

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Methods

mRNA-1345 coadministration with SD-SIIV4

mRNA-1345 coadministered with Moderna bivalent COVID-19 vaccine

PART A

PART B

RSV, respiratory syncytial virus; SD-SIIV4, standard dose seasonal influenza inactivated quadrivalent vaccine. aPlanned sample size: 420 participants.

ClinicalTrials.gov(opens in a new tab). NCT05330975. https://clinicaltrials.gov/ct2/show/NCT05330975.

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Results - Safety

Solicited adverse reactions within 7 days following vaccination

Solicited adverse reactions within 7 days after first vaccination

PART A

PART B

• Local and systemic adverse reactions were similar between the coadministration group and the mRNA-1345 group.
• Most adverse reactions were grade 1.
• Median onset was 1–2 days with a median duration of 2–2.5 days.

• Local adverse reactions were comparable between the coadministration group and the bivalent COVID-19 group.
• Systemic adverse reactions were numerically higher in the coadministration group compared to the bivalent COVID-19 group.
• Most adverse reactions were grade 1 and 2.
• Both median onset and duration were 2 days.

Unsolicited Adverse Reactions and Adverse Events (AEs) of Interest

• There were no reported cases of anaphylaxis, Guillain-Barré syndrome, acute disseminated encephalomyelitis, Bell's palsy/facial paralysis, acute myocarditis, or acute pericarditis.

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Results - Safety

PART A

PART B

AEs in the two groups were comparable.

• Codaministration: 8.3%
• mRNA-1345: 8.4%

Serious AEs (SAEs) were infrequent and reported similarly between the two groups:

• Coadministration 0.7%
• mRNA-1345: 1.2%

There were no reported deaths, SAEs, or AEs of special interest assessed or relayed by the investigator.

AEs in the coadministration group were higher than those in the bivalent COVID-19 group:

• Codaministration: 9.6%
• Bivalent COVID-19: 7.8% (mRNA-1345: 8.4%)

SAEs were infrequent and reported similarly between the two groups:

• Coadministration 0.7%
• Bivalent COVID-19: 0 (mRNA-1345: 0.2%)

There were no reported deaths, SAEs, or AEs of special interest assessed or relayed by the investigator.

mRNA-1345 coadministration with SD-SIIV4

mRNA-1345 coadministered with bivalent COVID-19 vaccine

Generally, the coadministration of mRNA-1345 with SD-SIIV4 (Part A) or with bivalent COVID-19 vaccine (Part B) was well tolerated

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Results - Immunogenicity

PART A - mRNA-1345 coadministration with SD-SIIV4

Noninferiority as demonstrated by RSV nAb and SIIV4HAI geometric mean titre ratios (GMR)

All success criteria were met.

Lower bound 95% CI of the GMR was >0.667 for:

• RSV-A (co-primary)
• All 4 influenza strains (co-primary)
• RSV-B (key secondary)

Geometric Mean Titre Ratios

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Results - Immunogenicity

PART A - mRNA-1345 coadministration with SD-SIIV4

Noninferiority partially met based on differences in seroresponse/seroconversion rates (SRR)

Success criteria partially met.

• Lower bound 95% CI of the SRR difference was >-10 for all 4 influenza strains (key secondary)
• Noninferiority criteria for RSV-A and RSV-B not met

Seroresponse/Seroconversion Rate Differences

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Results - Immunogenicity

Part B: mRNA-1345 coadministered with bivalent COVID-19 vaccine

Noninferiority as demonstrated by RSV nAb and SARS-CoV0-2 nAb geometric mean titre ratios

All success criteria were met.

Lower bound 95% CI of the geometric mean ratio (GMR) was >0.667 for:

• RSV-A (co-primary)
• Both SARS-CoV-2 strains (co-primary)
• RSV-B (key secondary

Geometric Mean Titre Ratios

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Results - Immunogenicity

Part B: mRNA-1345 coadministered with bivalent COVID-19 vaccine

Noninferiority partially met based on differences in seroresponse/seroconversion rates (SRR)

Success criteria partially met.

Co-primary:

• Noninferiority criteria for RSV-A and RSV-B not met

Key secondary:

• Lower bound 95% CI of the SRR difference was >-10 for all 4 influenza strains

Seroresponse/Seroconversion Rate Differences

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Conclusions

• The coadministration of mRNA-1345 with SD-SIIV4 (Part A) or of mRNA-1345 with Moderna bivalent COVID-19 vaccine (Part B) was generally well tolerated with an acceptable safety profile.
• Noninferiority was demonstrated for coadministration of:
• mRNA-1345 with SD-SIIV4 (5/6 co-primary endpoints met).
• mRNA-1345 with bivalent COVID-19 vaccine (6/6 co-primary endpoints met).

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🍁 Canadian Perspective

• The Goswami, et al. oral presentation showed that co-administration of RSV vaccines with either COVID-19 or influenza vaccines is important, as it shows these can be safe and effective, with no effect on reactogenicity or geometric mean titers.
• Co-administered vaccines have many pros, such as reducing administration time and workflow, patient time, and the idea of lumping the vaccines under the heading of respiratory vaccines, which may reduce hesitancy around the individual vaccines, such as is the case with the Twinrix Hepatitis A/B combination vaccine for travel.
• Regardless of implementing a co-administration vaccine, there will still be a need for administering single vaccines for those who have recently had COVID-19 and are therefore protected, or for those who are adamant about only having the one vaccine. For example, those under 65 years may prefer to only have the influenza vaccine, as we are seeing in Ontario at the moment.

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High-Risk Populations

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Canadian COVID-19 vaccine coverage among key vulnerable and hard-to-reach populations

Dr. Takoua Boukhris¹, Mr. Anton Maslov¹, Dr. Chantal Bacev-Giles¹ et al.

1. Centre for Immunization Surveillance and Programs, Public Health Agency of Canada

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Background

In January 2023, the Public Health Agency of Canada (PHAC) launched the Vulnerable and Hard-to-reach Populations COVID-19 Immunization Coverage Survey (VHCICS), a new surveillance initiative to:

• Enable projections and predictions for future immunization trends.
• Support the implementation of targeted interventions and the prevention of infectious disease outbreaks among vulnerable and hard-to-reach populations.
• Address missing or insufficient data and support the development of targeted vaccination programs, communications and recommendations for vulnerable and hard-to-reach populations.
• Inform prioritization and decision-making around immunization initiatives related to COVID-19 vaccination in vulnerable and hard-to-reach populations.

Within the vulnerable and hard-to-reach populations, this study examined:

• COVID-19 vaccination status and trends over year.
• Motivators for and barriers against immunization.

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Methods

The survey was conducted over a period of two cycles (in 2023 and 2024) in Canadian adults from the general population as well as the key vulnerable and hard-to-reach populations below:

1. People with an income less than $60,000 a year
2. People with a lower education level (no studies further than high school)
3. Young adults (18–29 years of age)
4. Indigenous people living in urban settings
5. Visible minority groups (including Indigenous people)
6. Immigrant adults who have lived in Canada for less than 10 years
7. People residing in remote or rural areas
8. People who use illegal drugs (PWUD)
9. Health care workers (including volunteers)
10. People working in industrial or factory settings
11. Transportation workers, specifically truck drivers

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Results

COVID-19 vaccination coverage

​

2024: Vaccination with at least one dose was significantly lower among the vulnerable and hard-to-reach populations (88%) compared to the general population (93%).

• The lowest vaccination coverage was among transportation workers (76%) and those residing in remote and rural areas (78%).

​

2023: Vaccination with at least one dose was lower among the vulnerable and hard-to-reach populations (91%) compared to the general population (95%).

• The lowest vaccination coverage was again among transportation workers (86%) and those living in remote and rural areas (85%).

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Results

COVID-19 vaccination coverage with at least one dose, by year and population group, 2023 and 2024 VHCICS

*Statistically significant difference between 2023 and 2024

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Results – Reasons for Vaccination

• The top 5 reasons for vaccination were similar among all the key populations (combined) compared to the general population across the years.
• The top reason for individuals to be vaccinated was "to protect self/family/household" (55% vs 62%, respectively in 2023; 54% vs 52% respectively in 2024)

The top 5 reasons for receiving a COVID-19 vaccine, by population group 2023 VHCICS

The top 5 reasons for receiving a COVID-19 vaccine, by population group 2024 VHCICS

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Reasons for Non-Vaccination

• 2023: The top reason for respondents to not be vaccinated was concern about the possible side effects of vaccines (65% key populations combined vs 76% general population). This was the main reason for all sub-populations with the exception of transportation workers and industry workers.
• 2024: The top reason for respondents to not be vaccinated was concerns about safety or the possible side effects of vaccines (45% key populations combined vs 63% general population). This was the main reason for all sub-populations except for PWUD.
• "I feel/felt that the vaccine does not provide much protection, as you can still get COVID-19 even if vaccinated" was also commonly given as a reason for non-vaccination among all populations in both survey cycles (39% in 2024 and 61% in 2023 in key populations combined).

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COVID-19 vaccine hesitancy

• 2023: There was a greater likelihood of vaccine hesitancy in the key populations (38%) compared to the general population (29%).
• 2024: There was no difference in vaccine hesitancy found between the key populations (36%) and the general population (35%).
• There was no noticeable change in COVID-19 vaccine hesitancy between 2023 and 2024 for both the general population and the key populations (all combined and individual population group).

Hesitancy to receive COVID-19 vaccine, by year and population group, 2023 and 2024 VHCICS

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Conclusions

• Vulnerable and hard-to-reach populations have significantly lower COVID-19 vaccination coverage compared with the general population across years.
• Limitations of the study:
• The results are based on information that was self reported. There is the risk of recall bias.
• Sample recruitment was conducted as part of natural fallout so some key populations (ie people who use drugs, industry workers, transportation workers) could not be targeted.

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🍁 Canadian Perspective

• The Boukhris, et al. poster discusses factors that are associated with the lowest vaccination rates. These are not a surprise and were the same as those seen with COVID-19 vaccination, such as those in hard-to-reach areas, new Canadians, people who do shift work, and mobile populations, such as those who work in transportation.
• Many of these groups may have beliefs around vaccination and their potential side effects that need to be addressed, and these familial and personal beliefs may be more important to them than the potential benefits to the healthcare system. However, many will be motivated by wanting to keep other vulnerable family members safe, so there are also a lot of positive motivational factors that can be addressed. Being transparent about the risk of side effects is important, while outlining the risks and consequences of a serious infection is important.
• Community engagement is critical in these populations and involving community members who can relate to the target populations in outreach initiatives to better reach high-risk groups. Access is also an important piece, as many of these people may not live close to medical centers or may work atypical hours.

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Strategies to increase vaccine uptake: people experiencing homelessness, drug use, mental illness

Savannah Torres-Salbach¹, Daria Tai², Sandra Chyderiotis², Stephanie Elliott²

1. Dalla Lana School of Public Health, University of Toronto; 2. Immunization Support & Knowledge Mobilization Unit, Public Health Agency of Canada

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Background

• People who use drugs (PWUD), people with severe and persistent mental illness (PSPMI), and people experiencing homelessness (PEH) encounter unique challenges to vaccine access including:
• Incomplete health records
• Logistical challenges
• Distrust in many institutions
• These populations experience low vaccination coverage. High rates of infection hospitalization and fatality are frequently reported (e.g. COVID-19 and Hepatitis B).
• There is an opportunity to advance health equity in these communities by initiating proactive strategies to increase vaccine uptake

Methods

• This study in February 2024 involved a search of PubMed/Medline, Scopus, and Embase for studies published between 2014 and 2024 in French or English.

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Characteristics of immunization strategies

Strategies*

*The % do not add up to 100% as many studies included varied strategies

Settings*

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Strategy Implementation

Barriers

Facilitators

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Key Findings

Adaptable immunization programs�Creating flexible vaccination programs and expanding the scope of practice providers helped to keep up with changing public health guidelines and to maximize the reach of vaccination strategies.

Leveraging trauma-informed principles�Creating environments of safety, peer support, and trustworthiness facilitated the building of meaningful relationships with patients. As a result, decreased the risk of re-traumatizing people with lived and living experience of mental illness, drug use, or homelessness.

Facilitating interprofessional collaboration and coordination�Leveraging coordination between physicians, pharmacists, nurses, and allied health professionals strengthened the comprehensiveness, efficiency, and acceptance of strategies by target populations. This facilitated better connections to care.

Utilizing mobile delivery models�Using mobile vaccine vans in syringe access programs and shelters helped bring vaccines to the target populations. It also helped address other social and health needs.

Using informatics tools and data systems�Leveraging informatics tools, data systems, and surveillance enabled identification of unvaccinated populations and facilitated the notification of providers for follow-up care.�

Leveraging community partnerships�Centering the needs of populations through community partnership was instrumental in customizing vaccination strategies to the needs of these populations and in fostering trust.

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Implications and Conclusions

• Through this review we identified 26 distince immunization strategies that effectively promoted vaccine uptake among PEH, PWUD, and/or PSPMI populations.
• Team-based primary care is key for increasing vaccine uptake in these populations. Initiatives and policies that support integration of vaccination with other health and support services are critical.
• Community participation in vaccinations programs and policy-making is crucial to improving health equity.

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🍁 Canadian Perspective

• The Torres-Salbach, et al. poster addresses another high-risk population; those who are homeless, use drugs, or struggle with mental illness. The study is a meta-analysis of published literature, which includes some well-designed studies.
• As in the previous poster, themes such as engaging community members in the outreach, working with local resources, considering transportation needs, and developing relationships all came up as important facilitators.
• Access is critical, so mobile vaccination clinics can be very useful, as it is very hard to deny an intervention that is beneficial when there is no work involved to receive it. Including a social element such as coffee and snacks can also be motivating, as it can also provide a place to gather socially and normalize the experience.

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An overview of immunization against SARS-CoV-2 in patients with hematologic malignancies

C. Arianne Buchan^1,2, Sita Bhella^3,4, Katrina Hueniken³, Michael Sebag⁵

1. Ottawa Hospital Research Institute, Ottawa, ON; 2. The University of Ottawa, Ottawa, ON; 3. Princess Margaret Cancer Centre, Toronto, ON; 4. The University of Toronto; 5. McGill University Health Centre, QC

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Background

As COVID-19 becomes an endemic illness, there is a need for clearer guidance on vaccination schedules, particularly with regards to the frequency of booster doses in patients with hematological malignancies.

Methods

954 patients with hematological malignancies were enrolled in the study across 12 Canadian sites between August 2021 and January 2023.

Results

The data from 789 participants in the study were analysed.

Baseline Characteristics

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Results

• Participants received up to 6 vaccine doses with >90% reporting receipt of 3 doses.

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Results

The study investigated humoral immunity across the different disease subgroups.

• Patients with lymphoma showed the lowest average proportion of positive anti-S antibodies (adjusted odds ratio (aOR) 0.46 95% CI 0.26, 0.81).
• Patients treated with anti-CD20 therapies exhibited low humoral immune response (aOR 0.25 95% CI 0.16, 0.40).
• Doses 4 and 5 showed improvements in percentage of patients who had positive anti-S antibodies.

Proportion of positive anti-S antibody after dose 4, 5, and 6 by disease subgroup

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Conclusions

This study demonstrates the heterogeneity of humoral immunity between patients with different hematological malignancies, and the increased humoral immune response with additional vaccine doses after dose 3.

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🍁 Canadian Perspective

• In the final poster, Buchan, et al. discusses the importance of vaccination in patients with hematologic malignancies.
• There have definitely been randomized trials confirming that in patients with certain hematologic malignancies, vaccines are less effective at increasing antibody levels. However, it is important to remember that this is a heterogeneous group, with some malignancies and their treatments allowing for the development of antibodies more than others.
• In these groups, vaccination is even more important and can be facilitated by the medical team that surrounds such patients. Therefore, collaboration between the different health care providers is important.
• For these patients with hematologic malignancies, having the maximum number of doses available, access to treatment, and testing is important. For a small cohort with an extensive medical team, there should be enough bandwidth for vaccination to be prescribed and administered.

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Full Congress Summary

Access to the full online congress summary can be found here: https://www.impactmedicom.com/congress-summaries

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