Publications by authors named "Macy Zou"

5 Publications

  • Page 1 of 1

Influenza Vaccine Does Not Increase the Risk of Coronavirus or Other Noninfluenza Respiratory Viruses: Retrospective Analysis From Canada, 2010-2011 to 2016-2017.

Clin Infect Dis 2020 11;71(16):2285-2288

Institut National de Santé Publique du Québec, Quebec City, Canada.

Influenza vaccine effectiveness against influenza and noninfluenza respiratory viruses (NIRVs) was assessed by test-negative design using historic datasets of the community-based Canadian Sentinel Practitioner Surveillance Network, spanning 2010-2011 to 2016-2017. Vaccine significantly reduced the risk of influenza illness by >40% with no effect on coronaviruses or other NIRV risk.
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http://dx.doi.org/10.1093/cid/ciaa626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314125PMC
November 2020

A Computerized Frailty Assessment Tool at Points-of-Care: Development of a Standalone Electronic Comprehensive Geriatric Assessment/Frailty Index (eFI-CGA).

Front Public Health 2020 31;8:89. Epub 2020 Mar 31.

Health Sciences and Innovation, Surrey Memorial Hospital, Surrey, BC, Canada.

Frailty is characterized by loss of biological reserves and is associated with an increased risk of adverse health outcomes. Frailty can be operationalized using a Frailty Index (FI) based on the accumulation of health deficits; items under health evaluation in the well-established Comprehensive Geriatric Assessment (CGA) have been used to generate an FI-CGA. Traditionally, constructing the FI-CGA has relied on paper-based recording and manual data processing. As this can be time-consuming and error-prone, it limits widespread uptake of this proven type of frailty assessment. Here, we report the development of an electronic tool, the eFI-CGA, for use on personal computers by frontline healthcare providers, to collect CGA data and automate FI-CFA calculation. The ultimate goal is to support early identification and management of frailty at points-of-care, and make uptake in Electronic Medical Records (EMR) feasible and transparent. An electronic CGA (eCGA) form was implemented to operate on Microsoft's WinForms platform and coded using C# programming language. Users complete the eCGA form, from which items under the CGA evaluation are automatically retrieved and processed to output an eFI-CGA score. A user-friendly interface and secured data saving methods were implemented. The software was debugged and tested using systematically designed simulation data, addressing different logic, syntax, and application errors, and then tested with clinical assessment. The user manual and manual scoring were used as ground truth to compare eFI-CGA input and automated eFI score calculations. Frontline health-provider user feedback was incorporated to improve the end-user experience. The Standalone eFI-CGA software tool was developed and optimized for use on personal computers. The user interface adapted the design of paper-based CGA form to facilitate familiarity for clinical users. Compared to known scores, the software tool generated eFI-CGA scores with 100% accuracy to four decimal places. The eFI-CGA allowed secure data storage and retrieval of multiple types, including user input, completed eCGA form, coded items, and calculated eFI-CGA scores. It also permitted recording of actions requiring clinical follow-up, facilitating care planning. Application bugs were identified and resolved at various stages of the implementation, resulting in efficient system performance. Accurate, robust, and reliable computerized frailty assessments are needed to promote effective frailty assessment and management, as a key tool in health care systems facing up to frailty. Our research has enabled the delivery of the standalone eFI-CGA software technology to empower effective frailty assessment and management by various healthcare providers at points-of-care, facilitating integrated care of older adults.
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http://dx.doi.org/10.3389/fpubh.2020.00089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137764PMC
March 2020

Influenza vaccine effectiveness by A(H3N2) phylogenetic sub-cluster and prior vaccination history: 2016-17 and 2017-18 epidemics in Canada.

J Infect Dis 2020 Mar 26. Epub 2020 Mar 26.

Institut National de Santé Publique du Québec, Québec, Canada.

Background: The influenza A(H3N2) vaccine was updated from clade 3C.3a in 2015-16 to a clade 3C.2a strain for both 2016-17 and 2017-18. Circulating 3C.2a viruses showed considerable diversity in the hemagglutinin glycoprotein and the egg-adapted vaccine strain also bore mutations, notably T160K loss-of-glycosylation.

Methods: Vaccine effectiveness (VE) in 2016-17 and 2017-18 was assessed by test-negative-design, explored by A(H3N2) phylogenetic sub-cluster and prior season's vaccination history.

Results: In 2016-17, A(H3N2) VE was 36%(95%CI=18-50%): comparable with (43%;95%CI=24-58%) or without (33%;95%CI=-16-64%) prior vaccination in 2015-16. In 2017-18,VE was 14%(95%CI=-8-31%):lower with (9%;95%CI=-18-30%) versus without (45%;95%CI=-7-71%) prior vaccination in 2016-17.

Conclusions: Exploring VE by phylogenetic sub-cluster and prior vaccination history reveals informative heterogeneity, but requires enhanced sample-size. Pivotal mutations conferring loss-of-glycosylation, and repeat vaccination with unchanged antigen, may be associated with reduced VE.
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http://dx.doi.org/10.1093/infdis/jiaa138DOI Listing
March 2020

Interim estimates of 2019/20 vaccine effectiveness during early-season co-circulation of influenza A and B viruses, Canada, February 2020.

Euro Surveill 2020 02;25(7)

Centre Hospitalier Universitaire de Québec, Québec, Canada.

Interim results from Canada's Sentinel Practitioner Surveillance Network show that during a season characterised by early co-circulation of influenza A and B viruses, the 2019/20 influenza vaccine has provided substantial protection against medically-attended influenza illness. Adjusted VE overall was 58% (95% confidence interval (CI): 47 to 66): 44% (95% CI: 26 to 58) for A(H1N1)pdm09, 62% (95% CI: 37 to 77) for A(H3N2) and 69% (95% CI: 57 to 77) for influenza B viruses, predominantly B/Victoria lineage.
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http://dx.doi.org/10.2807/1560-7917.ES.2020.25.7.2000103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043051PMC
February 2020

Paradoxical clade- and age-specific vaccine effectiveness during the 2018/19 influenza A(H3N2) epidemic in Canada: potential imprint-regulated effect of vaccine (I-REV).

Euro Surveill 2019 Nov;24(46)

Centre Hospitalier Universitaire de Québec, Québec, Canada.

IntroductionThe Canadian Sentinel Practitioner Surveillance Network reports vaccine effectiveness (VE) for the 2018/19 influenza A(H3N2) epidemic.AimTo explain a paradoxical signal of increased clade 3C.3a risk among 35-54-year-old vaccinees, we hypothesise childhood immunological imprinting and a cohort effect following the 1968 influenza A(H3N2) pandemic.MethodsWe assessed VE by test-negative design for influenza A(H3N2) overall and for co-circulating clades 3C.2a1b and 3C.3a. VE variation by age in 2018/19 was compared with amino acid variation in the haemagglutinin glycoprotein by year since 1968.ResultsInfluenza A(H3N2) VE was 17% (95% CI: -13 to 39) overall: 27% (95% CI: -7 to 50) for 3C.2a1b and -32% (95% CI: -119 to 21) for 3C.3a. Among 20-64-year-olds, VE was -7% (95% CI: -56 to 26): 6% (95% CI: -49 to 41) for 3C.2a1b and -96% (95% CI: -277 to -2) for 3C.3a. Clade 3C.3a VE showed a pronounced negative dip among 35-54-year-olds in whom the odds of medically attended illness were > 4-fold increased for vaccinated vs unvaccinated participants (p < 0.005). This age group was primed in childhood to influenza A(H3N2) viruses that for two decades following the 1968 pandemic bore a serine at haemagglutinin position 159, in common with contemporary 3C.3a viruses but mismatched to 3C.2a vaccine strains instead bearing tyrosine.DiscussionImprinting by the first childhood influenza infection is known to confer long-lasting immunity focused toward priming epitopes. Our findings suggest vaccine mismatch may negatively interact with imprinted immunity. The immunological mechanisms for imprint-regulated effect of vaccine (I-REV) warrant investigation.
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http://dx.doi.org/10.2807/1560-7917.ES.2019.24.46.1900585DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864978PMC
November 2019