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Many families express hesitancy around immunizing their children against COVID-19. We sought to better understand the perspectives of vaccine hesitant caregivers, and develop targeted recommendations for health care workers and policymakers to engage in more effective vaccine discussions.We conducted semi-structured telephone interviews with 23 caregivers recruited from a pediatric infectious diseases clinic, including a subset of patients referred to discuss vaccine hesitancy. Thematic analysis of the interviews identified themes that were mapped using behavior change models to identify perceived barriers and facilitators towards COVID-19 immunization.Barriers and facilitators were mapped to the WHO (World Health Organization) 3C's (confidence, complacency, convenience) model of vaccine hesitancy as well as the COM-B (capability, opportunity, motivation) behavior change model. Barriers included mistrust in authorities, misperception of the risk of COVID-19 in children, and perceived health contraindications and negative previous vaccine experiences. Facilitators included positive relationships with healthcare workers, the promise of a "return to normal", and societal pressures to immunize.Efforts to increase vaccine uptake in the pediatric population must target specific barriers and facilitators to immunization expressed by caregivers. To address these concerns, we suggest: 1. Educating hesitant caregivers by highlighting the long-term pandemic effects on children and the threat of COVID-19 to children's health, 2. Building on the trust caregivers have in healthcare workers by involving frontline workers in public health policy, and 3. Harnessing the power of peer pressure by mobilization of societal pressures and establishing COVID-19 vaccination as the norm in children.

Background: Resources to improve antimicrobial stewardship (AS) are limited, but a telestewardship platform can enable capacity building and scalability. The Alberta Telestewardship Network (ATeleNet) was designed to focus on outreach across the province of Alberta, Canada, and facilitate AS activities. Methods: Outreach occurred virtually between pharmacists and physicians in hospital and long-term care settings throughout Alberta via secure, enterprise video conferencing software on both desktop and mobile devices. We used a quantitative questionnaire adapted from the telehealth usability questionnaire to capture the health provider’s experience during each session. The questionnaire consisted of 39 questions, and a 5-point Likert scale was used to assess the degree of agreement and collate responses into a descriptive analysis. Results: A total of 33 pilot consultations were completed between July 6, 2020 and December 15, 2021. The majority (22, 85%) of respondents agreed that video conference-based virtual sessions are an acceptable means to provide health care and that they were able to express themselves effectively to other health care professionals (23, 88%). Respondents agreed the system was simple to use (23, 96%), and that they could become productive quickly using the system (23, 88%). Overall, 24 (92%) respondents were satisfied or very satisfied with the virtual care platform. Conclusions: We implemented and evaluated a telehealth consultation and collaborative care service between AS providers at multiple centres. AHS has since prioritized similar workflows, including access to specialists in acute care, as part of their virtual health strategy. Evaluation results will be shared with provincial stakeholders for further strategic planning and deployment.

Points cles Les agents biologiques a base d’anticorps monoclonaux, parfois appeles produits biologiques, ont revolutionne le traitement et la qualite de vie de nombreux patients atteints de maladies inflammatoires et auto-imunes[1][1]. Compte tenu des donnees emergentes concernant l’

KEY POINTS Monoclonal antibody biologics, also known as biologics, have revolutionized the treatment and quality of life of many patients with inflammatory and autoimmune conditions. [1][1] Women of reproductive age are increasingly using these agents to maintain disease remission because of

To estimate the risk of recurrence of adverse events following immunization (AEFIs) upon revaccination and to determine among patients with suspected vaccine allergy whether allergy skin test positivity was associated with AEFI recurrence.This prospective observational study included patients assessed in the Canadian Special Immunization Clinic Network from 2013 to 2019 with AEFIs who required revaccination with the vaccine temporally associated with their AEFI. Participants underwent standardized assessment and data collection. Special Immunization Clinic physicians used guidelines to inform their recommendations. Participants were followed up after revaccination to capture AEFI recurrences. Data were transferred to a central database for descriptive analysis.Overall, 588 participants were assessed for 627 AEFIs; 570 (91%) AEFIs occurred in children18 years of age. AEFIs included immediate hypersensitivity (130/627; 21%), large local reactions (110/627; 18%), nonurticarial rash (51/627; 8%), seizures (26/627; 4%), and thrombocytopenia (11/627; 2%). Revaccination was recommended to 513 of 588 (87%) participants. Among participants recommended and due for revaccination during the study period, 63% (299/477) were revaccinated. AEFI recurrence was 10% (31/299) overall, 31% (15/49) for large local reactions, and 7% (5/66) for immediate hypersensitivity. No recurrence was serious. Among 92 participants with suspected vaccine allergy who underwent skin testing and were revaccinated, the negative predictive value of skin testing for AEFI recurrence was 96% (95% CI 92.5%-99.5%).Most individuals with AEFIs were safely revaccinated. Among those with suspected vaccine allergy, skin testing may help determine the safety of revaccination.

Coronavirus disease (COVID-19) chilblains is a well-reported cutaneous pattern of severe acute respiratory syndrome coronavirus (SARS-CoV-2). Through this narrative review, we provide an evidence-based overview of idiopathic and secondary chilblains, distinguishing features of COVID-19 chilblains, and a systematic clinical approach to history, examination, investigations, and treatment. In the absence of cold or damp exposure, COVID-19 should be considered as a cause of acute chilblains. The timing of onset of COVID-19 chilblains relative to active SARS-CoV-2 viremia remains unclear. Patients with suspected COVID-19 chilblains should thus follow public health guidelines for COVID-19 testing and self-isolation.

Background The rollout of COVID-19 vaccines has brought vaccine hesitancy to the forefront in managing this pandemic. COVID-19 vaccine hesitancy is fundamentally different from that of other vaccines due to the new technologies being used, rapid development, and widespread global distribution. Attitudes on vaccines are largely driven by online information, particularly information on social media. The first step toward influencing attitudes about immunization is understanding the current patterns of communication that characterize the immunization debate on social media platforms. Objective We aimed to evaluate societal attitudes, communication trends, and barriers to COVID-19 vaccine uptake through social media content analysis to inform communication strategies promoting vaccine acceptance. Methods Social network analysis (SNA) and unsupervised machine learning were used to characterize COVID-19 vaccine content on Twitter globally. Tweets published in English and French were collected through the Twitter application programming interface between November 19 and 26, 2020, just following the announcement of initial COVID-19 vaccine trials. SNA was used to identify social media clusters expressing mistrustful opinions on COVID-19 vaccination. Based on the SNA results, an unsupervised machine learning approach to natural language processing using a sentence-level algorithm transfer function to detect semantic textual similarity was performed in order to identify the main themes of vaccine hesitancy. Results The tweets (n=636,516) identified that the main themes driving the vaccine hesitancy conversation were concerns of safety, efficacy, and freedom, and mistrust in institutions (either the government or multinational corporations). A main theme was the safety and efficacy of mRNA technology and side effects. The conversation around efficacy was that vaccines were unlikely to completely rid the population of COVID-19, polymerase chain reaction testing is flawed, and there is no indication of long-term T-cell immunity for COVID-19. Nearly one-third (45,628/146,191, 31.2%) of the conversations on COVID-19 vaccine hesitancy clusters expressed concerns for freedom or mistrust of institutions (either the government or multinational corporations) and nearly a quarter (34,756/146,191, 23.8%) expressed criticism toward the government’s handling of the pandemic. Conclusions Social media content analysis combined with social network analysis provides insights into the themes of the vaccination conversation on Twitter. The themes of safety, efficacy, and trust in institutions will need to be considered, as targeted outreach programs and intervention strategies are deployed on Twitter to improve the uptake of COVID-19 vaccination.

BACKGROUND There are concerns that vaccine hesitancy may impede COVID-19 vaccine rollout and prevent the achievement of herd immunity. Vaccine hesitancy is a delay in acceptance or refusal of vaccines despite their availability. OBJECTIVE We aimed to identify which people are more and less likely to take a COVID-19 vaccine and factors associated with vaccine hesitancy to inform public health messaging. METHODS A Canadian cross-sectional survey was conducted in Canada in October and November 2020, prior to the regulatory approval of the COVID-19 vaccines. Vaccine hesitancy was measured by respondents answering the question “what would you do if a COVID-19 vaccine were available to you?” Negative binomial regression was used to identify the factors associated with vaccine hesitancy. Cluster analysis was performed to identify distinct clusters based on intention to take a COVID-19 vaccine, beliefs about COVID-19 and COVID-19 vaccines, and adherence to nonpharmaceutical interventions. RESULTS Of 4498 participants, 2876 (63.9%) reported COVID-19 vaccine hesitancy. Vaccine hesitancy was significantly associated with (1) younger age (18-39 years), (2) lower education, and (3) non-Liberal political leaning. Participants that reported vaccine hesitancy were less likely to believe that a COVID-19 vaccine would end the pandemic or that the benefits of a COVID-19 vaccine outweighed the risks. Individuals with vaccine hesitancy had higher prevalence of being concerned about vaccine side effects, lower prevalence of being influenced by peers or health care professionals, and lower prevalence of trust in government institutions. CONCLUSIONS These findings can be used to inform targeted public health messaging to combat vaccine hesitancy as COVID-19 vaccine administration continues. Messaging related to preventing COVID among friends and family, highlighting the benefits, emphasizing safety and efficacy of COVID-19 vaccination, and ensuring that health care workers are knowledgeable and supported in their vaccination counselling may be effective for vaccine-hesitant populations.

Dupilumab is the only biologic therapy currently approved in Europe and the United States for severe atopic dermatitis in patients 6 years of age or older. Off-label use is rationalized in younger children with severe atopic dermatitis. Decisions about vaccination for children on dupilumab are complex and depend on both the child’s current treatment and the type of vaccination required. To achieve consensus on recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab, a review of the literature and a modified-Delphi process was conducted by a working group of 5 panelists with expertise in dermatology, immunology, infectious diseases and vaccination. Here, we provide seven recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab. These recommendations serve to guide physicians’ decisions about vaccination in children with atopic dermatitis treated with dupilumab. Furthermore, we highlight an unmet need for research to determine how significantly dupilumab affects cellular and humoral immune responses to vaccination with live attenuated and inactivated vaccines. Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00607-6.

BackgroundPublic support of public health measures including physical distancing, masking, staying home while sick, avoiding crowded indoor spaces and contact tracing/exposure notification applications remains critical for reducing spread of COVID-19. The aim of our work was to understand current behaviours and attitudes towards public health measures as well as barriers individuals face in following public health measures. We also sought to identify attitudes persons have regarding a COVID-19 vaccine and reasons why they may not accept a vaccine.MethodsA cross-sectional online survey was conducted in August 2020, in Alberta, Canada in persons 18 years and older. This survey evaluated current behaviours, barriers and attitudes towards public health measures and a COVID-19 vaccine. Cluster analysis was used to identify key patterns that summarize data variations among observations.ResultsOf the 60 total respondents, the majority of persons were always or often physically distancing (73%), masking (65%) and staying home while sick (67%). Bars/pubs/lounges or nightclubs were visited rarely or never by 63% of respondents. Persons identified staying home while sick to provide the highest benefit (83%) in reducing spread of COVID-19. There were a large proportion of persons who had not downloaded or used a contact tracing/exposure notification app (77%) and who would not receive a COVID-19 vaccine when available (20%) or were unsure (12%). Reporting health authorities as most trusted sources of health information was associated with greater percentage of potential uptake of vaccine but not related to contact tracing app download and use. Individuals with lower concern of getting and spreading COVID-19 showed the least uptake of public health measures except for avoiding public places such as bars. Lower concern regarding COVID-19 was also associated with more negative responses to taking a potential COVID-19 vaccine.ConclusionThese results suggest informational frames and themes focusing on individual risks, highlighting concern for COVID-19 and targeting improving trust for health authorities may be most effective in increasing public health measures. With the ultimate goal of preventing spread of COVID-19, understanding persons’ attitudes towards both public health measures and a COVID-19 vaccine remains critical to addressing barriers and implementing targeted interventions and messaging to improve uptake.

BACKGROUND The rollout of COVID-19 vaccines has brought vaccine hesitancy to the forefront in managing this pandemic. COVID-19 vaccine hesitancy is fundamentally different from that of other vaccines due to the new technologies being used, rapid development, and widespread global distribution. Attitudes on vaccines are largely driven by online information, particularly information on social media. The first step toward influencing attitudes about immunization is understanding the current patterns of communication that characterize the immunization debate on social media platforms. OBJECTIVE We aimed to evaluate societal attitudes, communication trends, and barriers to COVID-19 vaccine uptake through social media content analysis to inform communication strategies promoting vaccine acceptance. METHODS Social network analysis (SNA) and unsupervised machine learning were used to characterize COVID-19 vaccine content on Twitter globally. Tweets published in English and French were collected through the Twitter application programming interface between November 19 and 26, 2020, just following the announcement of initial COVID-19 vaccine trials. SNA was used to identify social media clusters expressing mistrustful opinions on COVID-19 vaccination. Based on the SNA results, an unsupervised machine learning approach to natural language processing using a sentence-level algorithm transfer function to detect semantic textual similarity was performed in order to identify the main themes of vaccine hesitancy. RESULTS The tweets (n=636,516) identified that the main themes driving the vaccine hesitancy conversation were concerns of safety, efficacy, and freedom, and mistrust in institutions (either the government or multinational corporations). A main theme was the safety and efficacy of mRNA technology and side effects. The conversation around efficacy was that vaccines were unlikely to completely rid the population of COVID-19, polymerase chain reaction testing is flawed, and there is no indication of long-term T-cell immunity for COVID-19. Nearly one-third (45,628/146,191, 31.2%) of the conversations on COVID-19 vaccine hesitancy clusters expressed concerns for freedom or mistrust of institutions (either the government or multinational corporations) and nearly a quarter (34,756/146,191, 23.8%) expressed criticism toward the government’s handling of the pandemic. CONCLUSIONS Social media content analysis combined with social network analysis provides insights into the themes of the vaccination conversation on Twitter. The themes of safety, efficacy, and trust in institutions will need to be considered, as targeted outreach programs and intervention strategies are deployed on Twitter to improve the uptake of COVID-19 vaccination.

Public health measures to reduce COVID-19 transmission include masking in public places, physical distancing, staying home when ill, avoiding high-risk locations, using a contact tracing app, and being willing to take a COVID-19 vaccine. However, adoption of these measures varies greatly. We aimed to improve health messaging to increase adherence to public health behaviours to reduce COVID-19 transmission by: 1) determining attitudes towards public health measures and current behaviours; 2) identifying barriers to following public health measures; and, 3) identifying public health communication strategies. We recruited participants from a random panel of 3000 phone numbers across Alberta to fill a predetermined quota: age (18–29; 30–59; 60+ years), geographic location (urban; rural), and whether they had school-age children. Two researchers coded and themed all transcripts. We performed content analysis and in-depth thematic analysis. Nine focus groups were conducted with 2–8 participants/group in August-September, 2020. Several themes were identified: 1) importance of public health measures; 2) compliance with public health measures; 3) critiques of public health messaging; and 4) suggestions for improving public health messaging. Physical distancing and masking were seen as more important than using a contact tracing app. There were mixed views around willingness to take COVID-19 vaccine. Current public health messaging was perceived as conflicting. Participants felt that consistent messaging and using social media to reach younger people would be helpful. In conclusion, these findings provide insights that can be used to inform targeted (e.g., by age, current behaviour) public health communications to encourage behaviors that reduce COVID-19 transmission.

Background Pregnant women with inflammatory bowel disease (IBD) are at increased risk of developing complications from vaccine-preventable infections. We investigated the factors influencing vaccine administration in pregnant women with IBD and their infants, in addition to the safety of vaccination in the infants. Methods This retrospective cohort study identified individuals from a tertiary referral clinic whose records were linked to a provincial vaccine database. We conducted χ 2 tests, Fisher exact tests, and logistic regression adjusting for age and disease duration to compare vaccine administration by medication class. Potential rotavirus vaccine adverse events were determined in infants of women with IBD. Results We included 303 pregnant women and 262 infants. Vaccines were administered to women on biologic therapy as follows: hepatitis B virus (82.9%), diphtheria-tetanus-pertussis (82.1%), and hepatitis A virus (49.3%). The influenza vaccination was provided peripartum in 50.7% of patients. The measles-mumps-rubella-varicella vaccine was provided to 89.3% of women before biologic initiation. Women treated with a biologic (adjusted odds ratio, 2.50; 95% confidence interval, 1.39-4.35) or immunomodulator (adjusted odds ratio, 4.00; 95% confidence interval, 2.22-7.69) were more likely to receive the Prevnar 13 and Pneumovax 23 vaccines than were unexposed individuals, but the overall proportion vaccinated was low (Prevnar 13, 35.7%; Pneumovax 23, 39.3%). At least 90% of infants received the measles-mumps-rubella-varicella vaccine and inactivated vaccines. Fourteen biologic-exposed children (19.2%) received the live rotavirus vaccine with no significant differences in adverse events compared with biologic-unexposed infants (7.1% vs 8.2%, P = 0.99). Conclusions Better education surrounding vaccine recommendations is required for both health care providers and individuals with IBD given poor pneumococcal, hepatitis A virus, and influenza vaccination rates. Inadvertent administration of the rotavirus vaccine in biologic-exposed infants did not result in more adverse events, raising the possibility of safety.

ObjectivesTo understand Canadian’s attitudes and current behaviours towards COVID-19 public health measures (PHM), vaccination and current public health messaging, to provide recommendations for a public health intervention.DesignTen focus groups were conducted with 2–7 participants/group in December 2020. Focus groups were transcribed verbatim and analysed using content and inductive thematic analysis. The capability opportunity motivation behaviour Model was used as our conceptual framework.SettingFocus groups were conducted virtually across Canada.ParticipantsParticipants were recruited from a pool of individuals who previously completed a Canada-wide survey conducted by our research team.Main outcome measureKey barriers and facilitators towards COVID-19 PHM and vaccination, and recommendations for public health messaging.ResultsSeveral themes were identified (1) participants’ desire to protect family and friends was the main facilitator for adhering to PHM, while the main barrier was inconsistent PHM messaging and (2) participants were optimistic that the vaccine offers a return to normal, however, worries of vaccine efficacy and effectiveness were the main concerns. Participants felt that current public health messaging is inconsistent, lacks transparency and suggested that messaging should include scientific data presented by a trustworthy source.ConclusionsWe suggest six public health messaging recommendations to increase adherence to PHM and vaccination (1) use an unbiased scientist as a spokesperson, (2) openly address any unknowns, (3) more is better when sharing data, (4) use personalised stories to reinforce PHM and vaccinations, (5) humanise the message by calling out contradictions and (6) focus on the data and keep politics out.

Coronavirus disease (COVID-19) chilblains is a well-reported cutaneous pattern of severe acute respiratory syndrome coronavirus (SARS-CoV-2). Through this narrative review, we provide an evidence-based overview of idiopathic and secondary chilblains, distinguishing features of COVID-19 chilblains, and a systematic clinical approach to history, examination, investigations, and treatment. In the absence of cold or damp exposure, COVID-19 should be considered as a cause of acute chilblains. The timing of onset of COVID-19 chilblains relative to active SARS-CoV-2 viremia remains unclear. Patients with suspected COVID-19 chilblains should thus follow public health guidelines for COVID-19 testing and self-isolation.

Background Data suggests that postpartum IBD patients have low self-reported vaccine rates despite being exposed to multiple care providers. To date, there is limited data on vaccine safety in infants exposed to biologic therapies in utero for the treatment of maternal IBD, with only questionnaire style studies and one case report of a fatal outcome post BCG vaccine. This has led to guidelines recommending against live vaccines under 6 months, such as the rotavirus vaccine, in biologic exposed infants. Aims To assess vaccine compliance in mothers with IBD and their infants and evaluate rotavirus safety to help optimize preventative medicine and guide future vaccine recommendations. Methods We obtained data from the University of Calgary’s Pregnancy in IBD Registry from 2012 to 2018 and from provincial vaccination and personal health records. Vaccine rates for Hep-A, Hep-B, Pneu-C-13, Pneu-C-23 and DTap were obtained for 117 mothers who received biologic therapy during pregnancy. Rotavirus (n=74 as it was introduced in ‘14) and DTap-IPV-Hib, Men-C, Pneu-C-13 and MMR (n=117) rates were obtained for infants exposed to biologics in utero. Rotavirus (n=92) and non-rotavirus (n=142) rates for non-biologic exposed infants were also collected. Rotavirus complications, characterized by related emergency room visits, were obtained. Descriptive statistics were performed with chi-square tests. Results We found the following rates of vaccine uptake in the biologic treated mothers: Hep-A (47%), Pneu-C-13 (32%), Pneu-C-23 (36%), Hep-B (75%) and DTap (79%). When comparing biologic and non-biologic exposed infants there were high rates of compliance for recommended vaccines with no differences in DTap-IPV-Hib (91% vs. 89%, p=0.11), Men-C (96% vs. 92%, p=0.80), Pneu-C-13 (95% vs. 93%, p=0.14) and MMR (96% vs. 92%, p=0.80). There was a significant difference in rotavirus rates (20% vs. 87%, n < 0.0001) given the recommendation against vaccination in biologic exposed infants. There was a significant difference in vaccination guideline adherence within the biologic group when comparing inappropriately administered rotavirus vaccines with inappropriately missed recommended vaccines (20% vs. 6%, p=0.02). No infants who received the rotavirus vaccine suffered from intussusception or death nor was there a significant difference in adverse events between the two groups (20% vs 9%; p=0.71). Conclusions The study highlights the need for improved vaccination education and implementation given suboptimal vaccine adherence in biologic treated mothers and the inadvertent administration of the live rotavirus vaccine in their biologic exposed infants. The lack of rotavirus vaccine adverse events shows potential vaccine safety in biologic exposed infants and requires further study. Funding Agencies None

Background There are concerns that vaccine hesitancy may impede COVID-19 vaccine rollout and prevent the achievement of herd immunity. Vaccine hesitancy is a delay in acceptance or refusal of vaccines despite their availability. Objective We aimed to identify which people are more and less likely to take a COVID-19 vaccine and factors associated with vaccine hesitancy to inform public health messaging. Methods A Canadian cross-sectional survey was conducted in Canada in October and November 2020, prior to the regulatory approval of the COVID-19 vaccines. Vaccine hesitancy was measured by respondents answering the question “what would you do if a COVID-19 vaccine were available to you?” Negative binomial regression was used to identify the factors associated with vaccine hesitancy. Cluster analysis was performed to identify distinct clusters based on intention to take a COVID-19 vaccine, beliefs about COVID-19 and COVID-19 vaccines, and adherence to nonpharmaceutical interventions. Results Of 4498 participants, 2876 (63.9%) reported COVID-19 vaccine hesitancy. Vaccine hesitancy was significantly associated with (1) younger age (18-39 years), (2) lower education, and (3) non-Liberal political leaning. Participants that reported vaccine hesitancy were less likely to believe that a COVID-19 vaccine would end the pandemic or that the benefits of a COVID-19 vaccine outweighed the risks. Individuals with vaccine hesitancy had higher prevalence of being concerned about vaccine side effects, lower prevalence of being influenced by peers or health care professionals, and lower prevalence of trust in government institutions. Conclusions These findings can be used to inform targeted public health messaging to combat vaccine hesitancy as COVID-19 vaccine administration continues. Messaging related to preventing COVID among friends and family, highlighting the benefits, emphasizing safety and efficacy of COVID-19 vaccination, and ensuring that health care workers are knowledgeable and supported in their vaccination counselling may be effective for vaccine-hesitant populations.

Background: Inappropriate prescribing behavior can be associated with higher rates of antibiotic resistance, calling for detailed studies on how physicians make prescribing decisions. We conducted a mixed-methods study to investigate physician antibiotic prescribing behavior in a 141-bed pediatric hospital. Methods: We applied a mixed-methods research design. The quantitative phase was conducted over a 6-month period to identify cases of inappropriate prescribing. The qualitative phase comprised 22 qualitative interviews with clinical teaching units (CTU) and pediatric intensive care unit (PICU) team members (physicians and pharmacists). Two coders analyzed the data deductively using the theoretical domain framework (TDF), as well as the social determinants of antimicrobial prescribing (SDAP). Results: In 52.9% of the 36 identified cases in the CTU and 31.4% of the 37 cases in the PICU, an infectious diseases (ID) consultation occurred. Compliance rates with ID recommendations were 79% and 91% in the CTU and PICU, respectively. The CTU and PICU expressed appreciation for ID involvement when ID supported their de-escalation choices in complex cases and in cases in which less commonly known antibiotics were used. However, the ID service involvement was perceived as detrimental to antimicrobial prescribing decisions for CTU and PICU across 3 of the 4 SDAP domains (Fig. 1, qualitative research quotes). Relationship between clinicians: CTU physicians and pharmacists perceived ID involvement as negatively impacting the relationship of the team. Antimicrobial decisions were automatically defaulted to ID, whereas pharmacy involvement was disregarded and the decisions were delayed. Risk, fear, and emotion: These were experienced across all respondents’ groups that identified ID specialists’ egos and personalities as contrary to open collaborative discussion on antimicrobial decisions. (Mis)perception of the problem: ID physicians were identified as more conservative in their antimicrobial choices, leading to prolonged duration of treatment, broader choices, and longer hospitalizations. The CTU and pharmacy respondents felt that ID recommendations were inconsistent among physicians and deviated from guidelines with little justification. Conclusions: Although CTU and PICU teams tend to comply with ID prescribing recommendations and ID involvement with complicated cases, pharmacists, CTU physicians, and PICU physicians perceived ID consultations to negatively affect collaborative efforts for stewardship. These findings offer novel insights into how an ID service can improve its role to positively affect appropriate prescribing. CTU and PICU respondents called for a supportive and trusting relationship with the ID service as a major driver for behavioral change and enhanced stewardship.Funding: NoneDisclosures: None

Antimicrobial stewardship (AS) programs are becoming a critical part of infectious diseases (ID) and medical microbiology training programs. As post-graduate medical education shifts toward competency-based medical education (CBME), the curriculum for AS training requires a similar transition. Our objective was to develop an educational curriculum combining principles of AS and CBME and apply a prospective audit and feedback (PAF) as an educational strategy.A new competency-based educational curriculum (CBEC) was created which addressed multiple stages along the competence continuum. The Centers for Disease Control and Prevention (CDC) core elements for AS were used to generate Entrustable Professional Activities (EPAs) and milestones for this CBEC.Trainees completed a PAF as an AS educational strategy on all antimicrobial starts in a pediatric hospital (141 beds) over a 1-month rotation. The PAF created 26 audits and addressed all (100%) of the CDC's core elements for inpatient AS programs through seven EPAs and 20 milestones.The PAF allowed for 26 interventions to improve effective antimicrobial use and mapped to multiple EPAs and milestones. Additionally, the PAF utilized all of the CDC's core elements for inpatient AS programs. It is imperative to ensure that educational strategies expose residents to AS interventions that have been shown to decrease antimicrobial usage in various settings. The current manuscript may serve as a model for how a CBEC can be developed, and how AS interventions can be integrated into a CBME program.Les programmes de gestion des antimicrobiens (GA) deviennent un élément essentiel des programmes d’enseignement en infectiologie et en microbiologie médicale. Tout comme l’enseignement médical postdoctoral évolue vers l’enseignement médical axé sur les compétences (EMAC), le curriculum d’enseignement de la GA doit subir une transition semblable. Les auteurs se sont donné l’objectif de concevoir un curriculum d’enseignement combinant les principes de GA et d’EMAC et d’opter pour la vérification et rétroaction prospectives (VRP) comme stratégie pédagogique.Les auteurs ont créé un nouveau curriculum d’enseignement axé sur les compétences (PEAC), lequel tient compte de multiples étapes dans le continuum des compétences. Ils ont utilisé les éléments fondamentaux desLes étudiants ont effectué une VRP, qui leur a servi de stratégie pédagogique de la GA à l’égard de tous les débuts d’antimicrobiens dans un hôpital pédiatrique (141 lits) pendant une rotation d’un mois. Cette VRP a donné lieu à 26 vérifications et tenu compte de tous les éléments fondamentaux des CDC (100 %) pour les programmes de GA auprès des patients hospitalisés, au moyen de sept APC et de 20 jalons.Grâce à la VRP, 26 interventions ont amélioré l’utilisation efficace des antimicrobiens, cartographiées en multiples APC et jalons. De plus, la VRP incluait tous les éléments fondamentaux des CDC relatifs aux programmes de GA auprès des patients hospitalisés. Il est impératif de prévoir des stratégies pédagogiques qui exposent les résidents à des interventions de GA, dont la capacité à réduire le recours aux antimicrobiens a été démontrée dans de multiples contextes. Le présent manuscrit peut servir de modèle pour élaborer un EMAC et pour savoir comment intégrer la GA à un programme d’EMAC.

Background Inappropriate antimicrobial use (AU) is recognized as a leading cause of antimicrobial resistance. However, quantifying AU in hospitals is challenging due to variability in information systems. Point prevalence surveys (PPS) provide a means to quantify AU in a cross-sectional manner within and between institutions. The aim of the study was to describe and compare the prescription patterns of AU across pediatric hospitals in Canada using PPS. Methods Two PPS (November 2018 and February 2019) were conducted at each of the 15 Canadian pediatric hospitals. For each PPS, AU data were collected for all inpatients ≤ 18 years (excluded mental health and birthing units) on the survey date. Data, including admitting diagnosis, age, comorbidities, Infectious Diseases consult, admitting service, documented pathogen(s), and antimicrobial(s) prescribed, was collected and entered into a RedCap database. Results In total, we surveyed 3826 patient-days. The mean proportion of children receiving at least one antimicrobial was 35.2% [range 25.1% to 42.9%]. Of the 1951 antimicrobials prescribed, the most common were third-generation cephalosporins [3GC] (16%; 321), aminopenicillins (15%; 297), TMP-SMX (11%; 207), piperacillin–tazobactam (10%; 193) and first-generation cephalosporins (9%; 181). Overall, the frequency of carbapenems, quinolones and vancomycin use was 4% (79), 3% (65) and 8% (151), respectively. Of the antimicrobials used for targeted or empiric therapy (n = 1541), 373 (24.2%) were for pneumonia, 278 (18%) for intra-abdominal infections and 251 (16.3%) for fever without a source. For the treatment of community-acquired pneumonia (CAP) (n = 178), aminopenicillins and 3GC use was 31% and 37%, respectively. Conclusion Our study used a standardized approach to assess AU to obtain benchmarking data for Canadian pediatric hospitals. About one-third of children hospitalized in Canadian pediatric hospitals are prescribed at least one antimicrobial. Of patients on treatment for CAP, only 31% were prescribed aminopenicillins. More detailed analysis of the rationale for AU, and assessment of appropriateness is required to fully understand antimicrobial prescribing practices in pediatric hospitals and develop stewardship initiatives. Disclosures All authors: No reported disclosures.

A 15-year-old boy, who had immigrated to Canada from the Philippines at the age of 11, presented to the emergency department with fever and acute onset of periumbilical abdominal pain that migrated to the right lower quadrant over 24 hours. Before this, he had experienced four months of intermittent

The Canadian Adverse Event Following Immunization Surveillance System (CAEFISS) receives reports via active syndromic surveillance for selected serious AEFI from the Canadian Immunization Monitoring Program Active (IMPACT) and via targeted passive surveillance from Federal/Provincial/Territorial health jurisdictions. Post-immunization seizure is a target of active and passive surveillance. Since 2009, the revised national AEFI reporting forms enable capture of terms specific to several Brighton Collaboration Case Definitions (BCCD) including generalized seizure and fever.To evaluate feasibility of applying the BCCD for generalized seizure to adverse event following immunization (AEFI) reports collected by IMPACT and targeted passive surveillance (non-IMPACT).Reports to CAEFISS coded as seizure in children2 years of age (vaccination dates 1998-2011) were reviewed retrospectively. A BCCD level (1-5 or unclassifiable) was assigned. The effects of reporting source (IMPACT versus non-IMPACT), seriousness [serious (e.g., hospitalized) versus non-serious], vaccination year (1998-2008 versus 2009-2011), and data submission method to CAEFISS (electronic versus paper) were assessed by stratified analysis.There were 459 IMPACT and 908 non-IMPACT cases analyzed, of which 99.6% and 27%, respectively, were serious reports. The revised reporting form that captured the BCCD components (2009-2011) was associated with increased proportions of IMPACT and non-IMPACT cases meeting the BCCD for generalized seizure.Incorporating the BCCD components (level of consciousness, motor manifestations and fever ≥38°C) into the national reporting form and guidelines appeared to improve the feasibility of their use in AEFI surveillance. This effect was more pronounced among active syndromic surveillance compared to targeted passive surveillance reports.