Shainoor J Ismail - Academia.edu (original) (raw)

Papers by Shainoor J Ismail

Canada Communicable Disease Report, 2015

Background: Individuals who are 2 years of age and over and at high risk for invasive pneumococca... more Background: Individuals who are 2 years of age and over and at high risk for invasive pneumococcal disease (IPD) (defined as those with functional or anatomic asplenia or sickle cell disease; hepatic cirrhosis; chronic renal failure or nephrotic syndrome; HIV infection; and immunosuppression related to disease or therapy) are recommended to receive one lifetime booster dose of polysaccharide 23-valent pneumococcal vaccine (Pneu-P-23) vaccine, in addition to age-and risk-specific recommendations for the conjugate 13-valent pneumococcal vaccine (Pneu-C-13). Adults aged 65 years and over are also considered at high risk for invasive pneumococcal disease (IPD). Objective: To determine the optimal time between initial vaccination with Pneu-P-23 and subsequent booster doses to protect against IPD in those at high risk for IPD. Methods: The National Advisory Committee on Immunization (NACI) conducted a systematic review of the literature on booster doses of pneumococcal vaccine for individuals at high risk for IPD disease. NACI reviewed the evidence considering the target population, safety, immunogenicity, efficacy, effectiveness of the vaccines, vaccine schedules, and other aspects of the overall immunization strategy, and then approved three specific recommendations. Results: For all individuals aged 2 years and over who are at high risk for IPD and who have received a dose of Pneu-P-23, re-vaccination with a second dose of Pneu-P-23 should be provided five years after the initial dose of Pneu-P-23. They should also have previously received age-appropriate doses of 13-valent conjugate pneumococcal vaccine. There is currently insufficient evidence to determine the optimal timing and number of Pneu-P-23 boosters in high-risk adults. One lifetime booster of Pneu-P-23 is currently recommended for individuals at high risk for IPD, five years after the previous dose. Given the increased risk of IPD in adults aged 65 years and older and the rapid decline in antibodies following Pneu-P-23, all individuals should receive one dose of Pneu-P-23 at age 65 years-as long as five years have passed since the previous Pneu-P-23 dose. No additional booster dose is currently recommended for this age group, if they have no medical conditions that put them at high risk for IPD. Conclusion: The new and complete set of current recommendations for pneumococcal vaccines will be published in the updated "Pneumococcal" chapter in the Canadian Immunization Guide in the near future.

Vaccine, Jun 1, 2021

Introduction: The National Advisory Committee on Immunization (NACI) makes recommendations for va... more Introduction: The National Advisory Committee on Immunization (NACI) makes recommendations for vaccines in Canada. To inform considerations for equity when making recommendations, the NACI Secretariat developed a matrix of factors that may influence vaccine equity. To inform the matrix we mapped the evidence for P 2 ROGRESS And Other factors potentially associated with unequal levels of illness or death from vaccine-preventable diseases (VPDs) and systematically reviewed the evidence for interventions aimed at reducing inequities. Methods: In October 2019 we searched Medline, Embase, and CINAHL. Two reviewers agreed on the included studies. Our primary outcomes were VPD-related hospitalizations and deaths. Secondary outcomes were differential vaccine access, and exposure, susceptibility, severity, and consequences of VPDs. Two reviewers appraised the certainty of evidence. We mapped the evidence for P 2 ROGRESS And Other factors and summarized the findings descriptively. We summarized the interventions narratively. Results: We identified 413 studies reporting on P 2 ROGRESS And Other factors. The most commonly investigated factors included age (n = 374, 89%), pre-existing conditions (n = 179, 42%), and gender identity or sex (n = 144, 34%). We identified 2 trials investigating the effects of interventions. One (n = 1249) provided very low certainty evidence that staff vaccination policies may reduce hospitalizations and deaths from influenza among private care home residents. The other (n not reported) provided very low certainty evidence that universal vaccination by nurses in clinics may reduce hospitalizations for rotavirus gastroenteritis compared with vaccination by physicians or no intervention. Conclusions: There is a large body of studies reporting on hospitalizations and deaths from VPDs stratified by P 2 ROGRESS And Other factors. We found only two trials examining the effects of interventions on hospitalization for or mortality from VPDs. This review has been helpful to NACI and will be helpful to similar organizations aiming to systematically identify and target health inequities through the development of vaccine program recommendations.

Social Science Research Network, 2020

The COVID-19 pandemic has exposed social inequities that rival biological inequities in disease e... more The COVID-19 pandemic has exposed social inequities that rival biological inequities in disease exposure and severity. Merely identifying some inequities without understanding all of them can lead to harmful misrepresentations and deepening disparities. Applying an ‘equity lens’ to bring inequities into focus without a vision to extinguish them is short-sighted. Interventions to address inequities should be as diverse as the pluralistic populations experiencing them. We present the first validated equity framework applied to COVID-19 that sheds light on the full spectrum of health inequities, navigates their sources and intersections, and directs ethically just interventions. The Equity Matrix also provides a comprehensive map to guide surveillance and research in order to unveil epidemiological uncertainties of novel diseases like COVID-19, recognising that inequities may exist where evidence is currently insufficient. Successfully applied to vaccines in recent years, this tool has resulted in the development of clear, timely and transparent guidance with positive stakeholder feedback on its comprehensiveness, relevance and appropriateness. Informed by evidence and experience from other vaccine-preventable diseases, this Equity Matrix could be valuable to countries across the social gradient to slow the spread of SARS-CoV-2 by abating the spread of inequities. In the race to SARS-CoV-2 vaccines, this urgently needed roadmap can effectively and efficiently steer global leadership towards equitable allocation with diverse strategies for diverse inequities. Such a roadmap has been absent from discussions on managing the COVID-19 pandemic, and is critical for our passage out of it.

Canada communicable disease report, Apr 20, 2015

Background: Human papillomavirus (HPV) infections are the most common sexually transmitted infect... more Background: Human papillomavirus (HPV) infections are the most common sexually transmitted infections. In the absence of vaccination, it is estimated that 75% of sexually active Canadians will have a sexually transmitted HPV infection at some point in their lives. Canada's National Advisory Committee on Immunization (NACI) has recommended a three-dose immunization schedule with HPV vaccine for females 9 years of age and older and for males between 9 and 26 years of age, since 2007 and 2012, respectively. Objective: To outline the evidence on a two-dose HPV vaccine schedule and to make recommendations for the optimal HPV immunization schedule in Canada. Methods: NACI reviewed the evidence used by the World Health Organization's (WHO's) Strategic Advisory Group of Experts (SAGE) on Immunization for the two-dose HPV immunization schedule recommended for immunocompetent girls 9 to 14 years of age and conducted an additional review of literature for studies not included in, or published after, the SAGE review. A knowledge synthesis was performed then NACI approved specific recommendations and elucidated the rationale and relevant considerations.

MMWR. Morbidity and Mortality Weekly Report, 2018

Vaccine, 2021

Background: Canada's National Advisory Committee on Immunization (NACI) provides guidance on the ... more Background: Canada's National Advisory Committee on Immunization (NACI) provides guidance on the use of vaccines in Canada. To support the expansion of its mandate to include considerations for vaccine acceptability when making recommendations, the NACI Secretariat developed a matrix of factors that influence acceptability. To inform and validate the matrix, we systematically reviewed evidence for factors that influence vaccine acceptability, and for interventions aimed at improving acceptability. Methods: On 10-11 October 2018 we searched four bibliographic databases, the Theses Canada Portal, and ClinicalTrials.gov. Two reviewers agreed on the included studies. From each study, we extracted information about the participants, intervention or exposure, comparator, and relevant outcomes. Due to heterogeneity in the reported factors and acceptability indicators we synthesized the findings narratively. We appraised the certainty of evidence using GRADE. For each vaccine-preventable disease we populated a matrix of factors for which there was evidence of an influence on acceptability. Results: One hundred studies (>1 million participants) contributed data relevant to the public, 16 (6191 participants) to healthcare providers, and three (84 participants) to policymakers. There were 43 intervention studies (~2 million participants). Across vaccines, we identified low certainty evidence for 70 factors relevant to the general population, 56 to high-risk groups, and 30 to healthcare providers. The perceived safety and importance of the vaccine, vaccination history, and receiving a recommendation from a healthcare provider were common influential factors. We found low certainty evidence that reminders for childhood vaccines and policies or delivery models for rotavirus vaccines could improve uptake and coverage. Evidence for other interventions was of very low certainty. Conclusions: The NACI vaccine acceptability matrix is useful for categorizing acceptability factors for the general public. Reminder systems may improve the uptake of childhood vaccines. Policies that make the rotavirus vaccine universally available and easily accessible may improve coverage.

Canada communicable disease report, Sep 6, 2018

Background: Steep increases in herpes zoster (HZ) incidence, hospitalization due to HZ and the ri... more Background: Steep increases in herpes zoster (HZ) incidence, hospitalization due to HZ and the risk of post-herpetic neuralgia as a complication of HZ occur in people over 50 years of age. Two HZ vaccines are currently authorized for use in those 50 years of age and older in Canada: a live attenuated zoster vaccine (LZV) authorized in 2008; and a recombinant subunit vaccine (RZV) authorized in October 2017. Objectives: To review current evidence and develop guidance on whether the previously authorized LZV (Zostavax ®) and/or the recently authorized RZV (Shingrix ®) vaccine should be offered to Canadians 50 years of age and older: 1) at a population-level, in publicly funded immunization programs; and 2) at an individual-level, to individuals wishing to prevent HZ, or by clinicians wishing to advise individual patients about preventing HZ. Methods: The National Advisory Committee on Immunization (NACI) Herpes Zoster Working Group developed a predefined search strategy to identify all eligible studies, assessed their quality, and summarized and analyzed the findings. A Cost Utility Analysis of LZV and RZV was also conducted from a health care system perspective. Recommendations were proposed according to NACI's evidence-based process. The strength of these recommendations was defined, and the Grade of evidence supporting them was identified. In light of the evidence, the recommendations were then considered and approved by NACI. Results: Five recommendations were developed for public health and individual-level decision-making. 1) RZV should be offered to populations/individuals ≥50 years of age without contraindications (Strong NACI Recommendation, Grade A evidence). 2) RZV should be offered to populations/individuals ≥50 years of age without contraindications who have previously been vaccinated with LZV (Strong NACI Recommendation, Grade A evidence). Re-immunization with two doses of RZV may be considered one year after LZV (Discretionary NACI Recommendation, Grade I evidence). 3) RZV should be offered to populations/individuals ≥50 years of age without contraindications who have had a previous episode of HZ (Strong NACI Recommendation, Grade B evidence). Immunization with two doses of RZV may be considered one year after the HZ episode (Discretionary NACI Recommendation, Grade I evidence). 4) LZV may be considered for immunocompetent populations/individuals ≥50 years of age without contraindications when RZV vaccine is contraindicated, unavailable or inaccessible (Discretionary NACI Recommendation, Grade A evidence). 5) RZV vaccine (not LZV) may be considered in immunocompromised adults ≥50 years of age on a case-by-case basis (Discretionary NACI Recommendation, Grade I evidence). Conclusion: Both vaccines have been shown to be safe and immunogenic and to reduce the incidence of HZ and post-herpetic neuralgia. Vaccine efficacy of LZV against HZ decreases with age at, and time since vaccination. The vaccine efficacy of RZV remains higher and appears to decline more slowly than vaccine efficacy of LZV across all age groups. Both vaccines are cost-effective in those 50 years of age and older compared with no vaccination, especially in those 65-79 years of age. RZV is more cost-effective than LZV.

BMJ Global Health, 2021

support policies that target systemic racism and protect the rights of racialised groups. ► Impro... more support policies that target systemic racism and protect the rights of racialised groups. ► Improve access to testing and vaccination (eg, mobile clinics, publicly funded interventions) for racialised populations without further stigmatisation or discrimination, including those without health insurance (eg, migrant workers, asylum seekers). ► Engage trusted community leaders/partners/elders and liaise with relevant organisations (eg, immigration and refugee departments) in planning for immunisation programmes and communication materials. ► Provide culturally appropriate educational and communication materials in a variety of languages, media platforms and venues. ► Have translators and supports (eg, community members) available in clinics. ► Enable improved IPC measures † to reduce exposure.

Canada communicable disease report, Oct 1, 2010

The National Advisory Committee on Immunization (NACI) provides the Public Health Agency of Canad... more The National Advisory Committee on Immunization (NACI) provides the Public Health Agency of Canada with ongoing and timely medical, scientific and public health advice relating to immunization. The Public Health Agency of Canada acknowledges that the advice and recommendations set out in this statement are based upon the best current available scientific knowledge and is disseminating this document for information purposes. People administering the vaccine should also be aware of the contents of the relevant product monograph(s). Recommendations for use and other information set out herein may differ from that set out in the product monograph(s) of the Canadian manufacturer(s) of the vaccine(s). Manufacturer(s) have sought approval of the vaccine(s) and provided evidence as to its safety and efficacy only when it is used in accordance with the product monographs. NACI members and liaison members conduct themselves within the context of the Public Health Agency of Canada's Policy on Conflict of Interest, including yearly declaration of potential conflict of interest.

CMAJ open, Jul 1, 2021

he World Health Organization declared the COVID-19 outbreak as a pandemic on Mar. 11, 2020. 1 By ... more he World Health Organization declared the COVID-19 outbreak as a pandemic on Mar. 11, 2020. 1 By December of the same year, the first doses of SARS-CoV-2 vaccine ("COVID-19 vaccine") were administered in Canada. 2 In the following months, several million doses became available, but this initial supply was not sufficient to vaccinate the entire population right away. 2 This context of staggered arrival of vaccine supply necessitated offering vaccines to some populations earlier than others. To inform the planning of provincial and territorial publicly funded COVID-19 vaccination programs, Canada's National Advisory Committee on Immunization (NACI) developed evidence-informed guidance related to the prioritization of key populations in the context of limited vaccine supply in November 2020, 3,4 December 2020 5 and February 2021. 6 The assessment of values and preferences of stakeholders is an important component of an ethically sound vaccine prioritization framework. The objective of our study was to conduct a priority-setting exercise to establish a Canadian expert stakeholder perspective early in the COVID-19 pandemic on the relative importance of pandemic vaccination strategies for different COVID-19 pandemic scenarios at the time of initial COVID-19 vaccine availability. Methods Design and setting The priority-setting exercise, which included a stakeholder survey, was conducted in July and August 2020. To establish an expert stakeholder perspective on the relative importance

Canadian Medical Association Journal, Nov 17, 2020

related-content POINTS CLÉS • L'immunisation au moyen d'un vaccin sûr et efficace permettrait d'a... more related-content POINTS CLÉS • L'immunisation au moyen d'un vaccin sûr et efficace permettrait d'accélérer le contrôle de la pandémie de maladie à coronavirus 2019 (COVID-19) et de réduire le risque de morbidité, de mortalité et de perturbation sociale qui en résulte.

Canada communicable disease report, Dec 1, 2016

Vaccine, Aug 1, 2020

For the successful implementation of population-level recommendations, it is critical to consider... more For the successful implementation of population-level recommendations, it is critical to consider the full spectrum of public health science, including clinical and programmatic factors. Current frameworks may identify various factors that should be examined when making evidence-informed vaccine-related recommendations. However, while most immunization guidelines systematically assess clinical factors, such as efficacy and safety of vaccines, there is no published framework outlining how to systematically assess programmatic factors, such as the ethics, equity, feasibility, and acceptability of recommendations. We have addressed this gap with the development of the EEFA (Ethics, Equity Feasibility, Acceptability) Framework, supported by evidence-informed tools, including Ethics Integrated Filters, Equity Matrix, Feasibility Matrix, and an Acceptability Matrix. The Framework and tools are based on five years of environmental scans, systematic reviews and surveys, and refined by expert and stakeholder consultations and feedback. For each programmatic factor, the EEFA Framework summarizes the minimum threshold for consideration and when further in-depth analysis may be required, which aspects of the factor should be considered, how to assess the factor using the supporting evidence-informed tools, and who should be consulted to complete the assessment. Research, particularly in the fields of vaccine acceptability and equity, has validated the utility and comprehensiveness of the tools. The Framework has been successfully used in Canada for clear, timely, transparent vaccine guidance with positive stakeholder feedback on its comprehensiveness, relevance and appropriateness. Applying the EEFA Framework allows for the systematic consideration of the spectrum of public health science without a delay in recommendations, complementing existing decision-making frameworks. This Framework will therefore be useful for advisory groups worldwide to integrate critical factors that could impact the successful and timely implementation of comprehensive, transparent recommendations, and will further the global objective of developing practical and evidence-informed immunization policies.

The Lancet Respiratory Medicine

Canada Communicable Disease Report, 2010

National Advisory Committee on Immunization (NACI) † VARICELLA VACCINATION TWO-DOSES RECOMMENDATI... more National Advisory Committee on Immunization (NACI) † VARICELLA VACCINATION TWO-DOSES RECOMMENDATIONS Une déclaration d'un comité consultatif (DCC) Comité consultatif national de l'immunisation (CCNI) † RECOMMANDATIONS RELATIVES à L'ADMINISTRATION DE DEux DOSES Du VACCIN CONTRE LA VARICELLE †La présente déclaration a été rédigée par D r B. Tan et D re S. Ismail et approuvée par le CCNI. †Membres : D re J. Langley (présidente), D re B. Warshawsky (vice-présidente), D re S. Ismail (secrétaire exécutive), D re N. Crowcroft , M me A

CMAJ Open

anadian correctional settings have witnessed several large SARS-CoV-2 outbreaks since the start o... more anadian correctional settings have witnessed several large SARS-CoV-2 outbreaks since the start of the COVID-19 pandemic. 1-3 Many of the risk factors that predispose correctional settings to SARS-CoV-2 outbreaksclose living conditions, 4,5 an aging and comorbid population, 5,6 and limited autonomy that affects access to health care 7,8-are nonmodifiable, underscoring the importance of SARS-CoV-2 vaccination. 9 The Canadian National Advisory Committee on Immunization prioritized residents and staff of congregate settings, such as correctional settings, for early SARS-CoV-2 vaccination in December 2020. 10 However, rates of vaccine uptake have remained historically low in Canadian prisons despite the routine availability and promotion of vaccination since the 1990s. 11 Given the disproportionate incarceration of people experiencing social and health inequities, 12-16 maximizing vaccine acceptance is essential in preventing morbidity and death from vaccine-preventable diseases among the 30 000 adults currently incarcerated in Canadian federal and provincial or territorial prisons.

Canada Communicable Disease Report, 2017

PLOS ONE, 2022

Background Vaccine uptake rates have been historically low in correctional settings. To better un... more Background Vaccine uptake rates have been historically low in correctional settings. To better understand vaccine hesitancy in these high-risk settings, we explored reasons for COVID-19 vaccine refusal among people in federal prisons. Methods Three maximum security all-male federal prisons in British Columbia, Alberta, and Ontario (Canada) were chosen, representing prisons with the highest proportions of COVID-19 vaccine refusal. Using a qualitative descriptive design and purposive sampling, individual semi-structured interviews were conducted with incarcerated people who had previously refused at least one COVID-19 vaccine until data saturation was achieved. An inductive–deductive thematic analysis of audio-recorded interview transcripts was conducted using the Conceptual Model of Vaccine Hesitancy. Results Between May 19-July 8, 2021, 14 participants were interviewed (median age: 30 years; n = 7 Indigenous, n = 4 visible minority, n = 3 White). Individual-, interpersonal-, and sys...

Vaccine: X, 2022

Introduction Canadian correctional institutions have been prioritized for COVID-19 vaccination gi... more Introduction Canadian correctional institutions have been prioritized for COVID-19 vaccination given the multiple outbreaks that have occurred since the start of the pandemic. Given historically low vaccine uptake, we aimed to explore barriers and facilitators to COVID-19 vaccination acceptability among people incarcerated in federal prisons. Methods Three federal prisons in Quebec, Ontario, and British Columbia (Canada) were chosen based on previously low influenza vaccine uptake among those incarcerated. Using a qualitative design, semi-structured interviews were conducted with a diverse sample (gender, age, and ethnicity) of incarcerated people. An inductive-deductive analysis of audio-recorded interview transcripts was conducted to identify and categorize barriers and facilitators within the Theoretical Domains Framework (TDF). Results From March 22-29, 2021, a total of 15 participants (n=5 per site; n=5 women; median age=43 years) were interviewed, including five First Nations people and six people from other minority groups. Eleven (73%) expressed a desire to receive a COVID-19 vaccine, including two who previously refused influenza vaccination. We identified five thematic barriers across three TDF domains: social influences (receiving strict recommendations, believing in conspiracies to harm), beliefs about consequences (believing that infection control measures will not be fully lifted, concerns with vaccine-related side effects), and knowledge (lack of vaccine-specific information), and eight thematic facilitators across five TDF domains: environmental context and resources (perceiving correctional employees as sources of outbreaks, perceiving challenges to prevention measures), social influences (receiving recommendations from trusted individuals), beliefs about consequences (seeking individual and collective protection, believing in a collective “return to normal”, believing in individual privileges), knowledge (reassurance about vaccine outcomes), and emotions (having experienced COVID-19-related stress). Conclusions Lack of information and misinformation were important barriers to COVID-19 vaccine acceptability among people incarcerated in Canadian federal prisons. This suggests that educational interventions, delivered by trusted health care providers, may improve COVID-19 vaccine uptake going forward.