Expressions of Intent for IPY 2007-2008 Activities

Expression of Interest Details

PROPOSAL INFORMATION

Evaluation of the impact of an immunisation program combining pneumococcal conjugated vaccine and inactivated influenza vaccine in Nunavik children, Province of Quebec, Canada  (Pneumococcal conjugated and influenza vaccines in Nunavik)

Outline
In the Nunavik region in the province of Quebec, hospitalizations for pneumonia are much more frequent than in the general population of Quebec and it is estimated that a quarter of children present hearing deficit by the age of 5 years. In the spring of 2002, a routine infant immunization program with the 7-valent pneumococcal conjugate vaccine (PCV-7) was implemented along with a catch-up for children younger than 5 years of age. In the fall of 2003, the trivalent inactivated influenza vaccine (TIV-3) was offered to all 6 to 23 months old children. The objective of the study is to evaluate the impact of this double immunization program in young Inuit children, and to study for the first time the ability of the PCV-7 combined with the TIV-3 to prevent respiratory infections and audiological sequelae due to otitis media. This entails the retrospective monitoring of 12 birth cohorts of children born between 1994 and 2005 up until the age of 5 years. The evaluation will be done in comparing the frequency rates of different indicators in three birth cohorts (1994-1996) not having received the PCV-7 and the TIV-3, in the following six cohorts (1997-2002) having been vaccinated with a number of doses less than the complete schedule and in the last three, having been recipients of a routine immunization program combining the PCV-7 and the TIV-3. The specific objectives of the study are to measure (1) the frequency of respiratory and middle ear infections before and after the implementation of the combined immunization program; (2) the frequency of the of antibiotic treatments caused by these pathologies; (3) the frequency of hospitalizations and transfers to hospitals situated in southern Quebec caused by respiratory infections; (4) the frequency of myringotomy and ventilation tube placement; and (5) the prevalence of anatomical and functional lesions of the middle ear at 5 years of age. Sources of information will include the provincial hospital discharge database, the registry of invasive pneumococcal strains received by the provincial reference laboratory, immunization charts and medical records detained by health centers and dispensaries, and results of audiology screening tests and diagnostic examinations. In the Nunavik region, an audiology screening test is routinely performed around the age of 5 years, combining audiometry, tympanometry and otoscopy. This program was implemented in 1984 and provides a unique opportunity to assess the effect of immunization to prevent audiological sequelae due to otitis media.

What significant advance(s) in relation to the IPY themes and targets can be anticipated from this project?
Acute respiratory infections and otitis media are major public health problems in all Arctic populations and the routine immunization of children using the influenza and pneumococcal vaccines has been implemented in the US and Canada but not in other countries. Results will be most useful for the scientific community and public health authorities in all the Arctic countries. Knowledge of the benefit of the the new immunization program will enhance the credibility of preventive medicine for the population and be a major incentive for health professionals in the arctic regions involved in preventive programs.

What international collaboration is involved in this project?
- The International Circumpolar Surveillance Project - "The burden of infectious diseases in Greenland-means of evaluation and reduction" EoI # 1107

FIELD ACTIVITY DETAILS

Geographical location(s) for the proposed field activities:
Region of Nunavik, province of Quebec, Canada

Approximate timeframe(s) for proposed field activities:
Arctic: Year 2006 (pilot project) 06/06 – 09/06      Year 2007 (analysis of pilot project and preparation of main project) 07/07 – 08/07      Year 2008 (main project) 04/08 – 01/09 Year 2009 (analysis of main project and dissemination of results) 07/09 – 08/09
Antarctic: n/a

Significant facilities will be required for this project:
No extra major logistic support /facilities required

Will the project leave a legacy of infrastructure?
All immunization records of children in Nunavik will be computerized and this could serve as a base for a permanent computerized system.

How is it envisaged that the required logistic support will be secured?
Commercial operator
Own support

Comercial airlines will be used for travels. Computing facility of the CHUQ research center will be used for data analysis and storage.

Has the project been "endorsed" at a national or international level?
the IPY AHHI coordinating proposal#167

PROJECT MANAGEMENT AND STRUCTURE

Is the project a short-term expansion (over the IPY 2007-2008 timeframe) of an existing plan, programme or initiative or is it a new autonomous proposal?
Yes
This new activity will be integrated within the existing program of International Circumpolar Surveillance and the Arctic Human Health Initiative.

How will the project be organised and managed?
The coordination of research activities in Nunavik will be made jointly by the Public Health Directorate of Nunavik (Dr Jean-François Proulx) and the Quebec University Hospital Research Centre (Dr Philippe De Wals). Coordination with the Arctic Human health Initiative and the of International Circumpolar Surveillance will be made trough the Arctic Investigations programs, CDC-Anchorage (Dr Alan Parkinson).

What are the initial plans of the project for addressing the education, outreach and communication issues outlined in the Framework document?
Full report of the investigation in French and English will be inserted into the Quebec National Public Health Institute website. A paper will be prepared for publication in a major scientific journal. Presentation of results will be made at scientific meetings and at continuing education sessions organized for health care workers in the arctic region. Results will also be reported to the media in the arctic region.

What are the initial plans of the project to address data management issues (as outlined in the Framework document)?
Data will be collected from provincial databases and immunization and medical records in health care centers in the Nunavik region. Record linkage and analysis will be performed at the CHUQ research center. After analysis, the database will be anonymized, stored and available for further analysis at the CHUQ research center. Full report of the investigation will be inserted into the Quebec National Public Health Institute website.

How is it proposed to fund the project?
A research grant (Can$42,972) was obtained from the Canadian Institutes of Health Research (#200409MOP-134260-POP-CFBA-56916) to conduct a pilot project aiming to evaluate the feasibility of the main project. For the main project, a new application will be made to the Government of Canada Program for International Polar Year 2007-2008.s

Is there additional information you wish to provide?
None

PROPOSER DETAILS

Dr Philippe De Wals
Département de Médecine sociale et préventive, Université Laval, Institut national de Santé publique du Québec (INSPQ), Centre de recherche du centre hospitalier universitaire de Québec (CHUQ)
Unité de recherche en santé publique du CHUQ-CHUL 2400, d’Estimauville, Beauport (Québec)
G1E 6G1
Canada

Tel: (1-418) 666 7000 #363
Mobile:
Fax: (1-418) 666 2776
Email:

Other project members and their affiliation

Other Information