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Infectious Diseases

Special Immunization Clinic Network to investigate vaccine safety issues: Optimizing the clinical management of patients with contraindication to vaccination and those with adverse events following immunization (AEFI) as a platform for observational research  

The purpose of this multi-centre study is to build a national network of expert clinicians to assess children who have experienced an adverse event following immunization (AEFI) or who have a medical condition for whom vaccination may be contraindicated in special immunization clinics. The occurrence of an AEFI or in patients with medical condition with a potential contraindication to vaccination raises concerns in patients, their parents, and vaccine providers regarding future vaccination. However, there is little scientific information to help in making the decision. The study aims to evaluate the risk of revaccination in these patients, including estimating the probability of recurrence of AEFIs after revaccination and identifying risk factors for recurrences. We hope this network will help to standardize clinical care and guide best practice in management of these patients. We hope that good scientific evidence can be built by this network of special immunization clinics to standardize clinical care and guide best practice in the clinical management and outcome of revaccination in these patients. 
 
Enrollment in this Study is ongoing.
 
Dr. Pham-Huy is the CHEO investigator on this study. Please contact Jennifer Bowes, Research Coordinator for the Division of Infectious Diseases, if you would like more information about this study.
 
Pediatric HIV Infection: Exploring Determinants of a Functional Cure

The development and refinement of combined antiretroviral therapy (cART) for the treatment of HIV has dramatically improved the health of people living with HIV. cART works by suppressing production of new HIV viruses and reducing to very low levels the amount of HIV circulating in the bloodstream. But while cART can suppress HIV replication, it cannot cure HIV or eliminate it from the body. That is because HIV becomes integrated into certain types of cells of the immune system, which can remain "latent" or inactive for years. It is these latently infected cells that make up the "viral reservoir" in that they can reactivate to produce virus if cART is stopped; the viral reservoir represents the main challenge to finding a cure to HIV. A previous Canadian study, involving CHEO investigators Drs. Samson and Brophy, found that in children who were infected with HIV around the time of birth and who started cART immediately, no HIV could be detected in their blood, and no HIV-specific immune responses could be detected. It appeared as though starting treatment immediately after infection had significantly limited the "viral reservoir". EPIC4 is a national study trying to better understand if the size of the HIV reservoir in children can be decreased by starting cART very early in life and remaining highly adherent to taking it. By limiting the HIV reservoir size, and understanding what other factors affect its dynamics, be able to "cured" of HIV and eventually stop medications. The  EPIC4 research team at CHEO and across 9 other pediatric centres in Canada are recruiting children and adults who were infected with HIV-1 from birth to participate in this study.

The study is led by Dr. Hugo Soudeyns, at CHU Sainte-Justine and University of Montreal; Dr. Brophy and Dr. Samson are the CHEO investigators on this study.

A population-based study of health outcomes of HIV-exposed uninfected children using Ontario’s administrative databases

Due to the success of antiretroviral treatment for HIV, the vast majority of children born to women living with HIV are not getting infected with HIV. As a result, the number of HIV-exposed, uninfected children (HEUs) is far exceeding the number of HIV-infected children both in Canada and around the world. However, there is also a growing need to better understand their potential risks to long term health due to these children’s exposures to both HIV and antiretroviral therapy during pregnancy. Some evidence suggests that HEUs do experience some negative health outcomes, however previous studies have not looked at these health outcomes at a population level to know what percentage are affected and with what severity. In this study, we will be using Ontario’s administrative health databases to examine various health outcomes of HEUs, including number of hospitalizations, number of infections, neurodevelopmental disorders and congenital birth defects. By looking at the population-based trends in health outcomes in this group, this project has the potential to greatly impact our understanding of how best to counsel mothers/parents living with HIV and provide care to their children.  

This study is led by Dr. Brophy, and was funded through the CHEO Research Institute ICES Research Grant.

Validation of the diagnostic and outcome-related codes for severe RSV within Ontario's Health Administrative Data housed at ICES

Acute lower respiratory tract infections are the leading cause of illness in young children, and Respiratory Syncytial Virus (RSV) is the most common virus causing this illness. The goal of this study is to determine risk factors that could accurately identify the group of children who develop severe RSV disease and would require hospital admission. The aim of the study is to validate the diagnostic and health services utilization codes in identifying cases of hospitalized RSV. If the validation is successful, we would be able to provide an accurate estimate of how often Ontario children are admitted to hospital due to RSV. The study would use health administrative data available at the Institute for Clinical Evaluative Sciences (ICES) to answer our research questions. Learning more about both risk factors and the long-term effects will give health care workers and policy makers the information they need to make decisions about severe RSV disease prevention and care in Ontario.

This study is being led by PIs Dr. McNally and Dr. Hui.

Acceptability, completion rates and cost effectiveness of a new 12 dose treatment (3 months) compared to the standard treatment for latent TB infection treatment (TAIMA TB 3HP Study)

The treatment of latent tuberculosis infection (LTBI) plays an important part in preventing ongoing transmission of TB by preventing the development of active TB disease. The current standard for the treatment of LTBI is 9 months of daily Isoniazid (INH), but adherence to this lengthy regimen is a big challenge. Rifapentine and INH (3HP) is another treatment option for LTBI that when directly observed once weekly for a total of 3 months is as effective as the 9 months of daily self-administered INH. This is a phase IV clinical study trial, led by Dr. Alvarez at the Ottawa Hospital, that is being conducted in Iqaluit, NU and ottawa, ON at both CHEO and the Ottawa Hospital. The primary objective of this study is to compare the proportion of people who complete directly observed prophylactic treatment using the new 3HP regimen to the current standard of 9 months INH. The efficacy and safety of this 3-month 3HP regimen has already been established, and the shortened treatment course could increase the number of people who accept and complete LTBI treatment. This ultimately could lead to a decrease in active TB cases.

Dr. Hui is the site investigator. Enrollment in this study is ongoing, with a goal of enrolling a total of 50 children from CHEO. Please contact Jennifer Bowes, research coordinator for the Division of Infectious Diseases, if you would like more information about this study.

Migrant Health and Development Research Initiative (MHADRI)

The Migrant Health and Development Research Initiative (MHADRI) is an international partnership of academic, policy and operational organisations aiming to improve the health and well being of migrants through research evidence. Dr. Hui is a founding member of MHADRI network member and is the vaccine preventable disease lead working on the European Centre for Disease Prevention and Control Infectious diseases recommendations for refugees to Europe.

Risk factors for severe influenza in children (FluGene Study)

This is a national, multicenter, prospective study looking to examine the contribution of clinical, viral, environmental and genetic factors in determining the severity of influenza infection in healthy Canadian children. The study hopes to determine the relationship between these potential risk factors and the development of respiratory complications, hospitalization, admission to intensive care unit and length of stay associated with influenza infection. By identifying clinical, viral and environmental factors associated with severe influenza in healthy children, we hope that we will be able to improve our ability to identify new risk groups that are vulnerable to influenza. The study has been ongoing for several years, and CHEO is one of the leading enrolling sites in Canada. The study is funded by the Canadian Institutes of Health Research and is led by a principal investigator at The Hospital for Sick Children.

Dr. Le Saux is the principal investigator for this study at CHEO. If you’re interested in learning more about this study, please contact Jennifer Bowes, research
coordinator for the Division of Infectious Diseases for more information.  

Immunization Monitoring Program ACTive (IMPACT)

The Immunization Monitoring Program ACTive (IMPACT) program is a paediatric hospital-based national active surveillance network for adverse events following immunization, and vaccine-preventable diseases in Canada. IMPACT involves 12 Canadian centres to monitor vaccine safety and the pattern of diseases that are currently or potentially vaccine-preventable in children. IMPACT surveillance is designed to detect any unexpected or unusual occurrences that result in hospitalization after vaccines are given and provide information on how well Canadian immunization programs work. It is ideally positioned to monitor any changes in event rates, new, signals of concern and emerging diseases. IMPACT is administered by the Canadian Paediatric Society with funding from the Centre for Immunization and Respiratory Infectious Diseases at the Public Health Agency of Canada.  

Dr. Le Saux is the principal investigator for this study at CHEO. If you’re interested in learning more about this study, please contact Jennifer Bowes, research
coordinator for the Division of Infectious Diseases for more information.
  
Antimicrobial stewardship initiatives at CHEO

Increasing antimicrobial resistance worldwide is making infections difficult to treat. Antimicrobial stewardship programs are being developed across health care facilities in order to promote judicious use of antimicrobials. Antimicrobial stewardship is the practice of correctly deciding who to treat as well as medication selection, dosing, route choice, and duration. The primary goal of antimicrobial stewardship is to optimize clinical outcomes while minimizing the adverse effects of antimicrobial use including toxicity, selection of particularly pathogenic organisms, and induction of resistance. Such programs may also help to reduce health care costs. CHEO has initiated antimicrobial stewardship programs in several wards of the hospital, including intensive care unit, general pediatric ward, and surgery. We have several studies aiming to evaluate these programs. The outcome of these studies focus on measuring the number of days of antimicrobial therapy, and determining if the amount of antimicrobial use has decreased after initiation of these antimicrobial stewardship programs.  Our hope is that these projects will provide important evaluation of the efficacy of the antimicrobial stewardship programs at CHEO.  

Dr. Le Saux is lead investigator on several antimicrobial stewardship studies at CHEO. If you’re interested in learning more about these studies, please contact Jennifer Bowes, research coordinator for the Division of Infectious Diseases for more information.  


 
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