COVID-19: A year later: The National Collaborating Centre for Healthy Public Policy in times of COVID-19: Building skills to “Build Back Better”

This article, the second in a series on the six National Collaborating Centres for Public Health, focuses on the National Collaborating Centre for Healthy Public Policy (NCCHPP), a centre of expertise, and knowledge synthesis and sharing that supports public health actors in Canada in their efforts to develop and promote healthy public policy.The article briefly describes the NCCHPP’s mandate and programming, noting some of the resources that are particularly relevant in the current coronavirus disease 2019 (COVID-19) context. It then discusses how the NCCHPP’s programming has been adapted to meet the changing needs of public health actors throughout the pandemic. These needs have been strongly tied to decisions aimed at containing the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and mitigating its immediate impacts in various societal sectors since the beginning of the crisis. Needs have also gradually emerged related to how public health is expected to help inform the development of public policies that will allow us to “build back better” societies as we recover from the pandemic. The article concludes by discussing the orientation of the NCCHPP’s future work as we emerge from the COVID-19 crisis.     

The authors reply

This is a reply to the commentary of Ossorio and Zhou.     

A review of the safety of vaccines used in routine immunization in Africa

BackgroundDespite the significant role played by vaccines in global health, concerns over vaccine safety have increased tremendously over the years. There have been occasions where vaccines have caused rare, adverse reactions some of which have led to hospitalizations and even death. It is therefore important to establish the safety profile of routinely used vaccines in order to allay fears pertaining to their use.ObjectivesThis review was aimed at pooling together the safety data of selected vaccines used for routine immunization in Africa, a region of the world with paucity of vaccine safety data.MethodsAdverse Events Following Immunization safety data was searched for rotavirus, yellow fever, measles, rubella, tuberculosis (Bacillus Calmette Guerin-BCG), pneumococcal, Haemophilus Influenza type b, polio, meningococcal and the influenza A (H1N1) vaccines in PUBMED, Google Scholar, Clinical trials.gov and Cochrane controlled register of trials databases.ResultsA total of twenty-four serious AEFIs and twenty-three minor AEFIs were identified from the review. The strength of association between AEFIs and vaccine was high for tuberculosis vaccine and moderate for all other vaccines.ConclusionEven though AEFIs (including mild and severe) were identified in the review, all the vaccines studied were generally well tolerated.     

Lung cancer incidence in young women vs. young men: A systematic analysis in 40 countries

Previous studies have reported converging lung cancer rates between sexes. We examine lung cancer incidence rates in young women vs. young men in 40 countries across five continents. Lung and bronchial cancer cases by 5-year age group (ages 30–64) and 5-year calendar period (1993–2012) were extracted from Cancer Incidence in Five Continents. Female-to-male incidence rate ratios (IRRs) and 95% confidence intervals (95%CIs) were calculated by age group and birth cohort. Among men, age-specific lung cancer incidence rates generally decreased in all countries, while in women the rates varied across countries with the trends in most countries stable or declining, albeit at a slower pace compared to those in men. As a result, the female-to-male IRRs increased among recent birth cohorts, with IRRs significantly greater than unity in Canada, Denmark, Germany, New Zealand, the Netherlands and the United States. For example, the IRRs in ages 45–49 year in the Netherlands increased from 0.7 (95% CI: 0.6–0.8) to 1.5 (95% CI: 1.4–1.7) in those born circa 1948 and 1963, respectively. Similar patterns, though nonsignificant, were found in 23 additional countries. These crossovers were largely driven by increasing adenocarcinoma incidence rates in women. For those countries with historical smoking data, smoking prevalence in women approached, but rarely exceeded, those of men. In conclusion, the emerging higher lung cancer incidence rates in young women compared to young men is widespread and not fully explained by sex differences in smoking patterns. Future studies are needed to identify reasons for the elevated incidence of lung cancer among young women.     

International trends in hepatocellular carcinoma incidence, 1978–2012

Primary liver cancer, the major histology of which is hepatocellular carcinoma (HCC), is the second leading cause of cancer death worldwide. We comprehensively examined recent international trends of primary liver cancer and HCC incidence using population-based cancer registry data. Incidence for all primary liver cancer and for HCC by calendar time and birth cohort was examined for selected countries between 1978 and 2012. For each successive 5-year period, age-standardized incidence rates were calculated from Volumes V to XI of the Cancer Incidence in Five Continents (CI5) series using the online electronic databases, CI5plus. Large variations persist in liver cancer incidence globally. Rates of liver cancer remain highest in Asian countries, specifically in the East and South-East, and Italy. However, rates in these high-risk countries have been decreasing in recent years. Rates in India and in most countries of Europe, the Americas and Oceania are rising. As the population seroprevalence of hepatitis B virus (HBV) continues to decline, we anticipate rates of HCC in many high-risk countries will continue to decrease. Treatment of hepatitis C virus (HCV) is likely to bring down rates further in some high-rate, as well as low-rate, countries with access to effective therapies. However, such gains in the control of liver cancer are at risk of being reversed by the growing obesity and diabetes epidemics, suggesting diabetes treatment and primary prevention of obesity will be key in reducing liver cancer in the longer-term.     

Safety and Efficacy of Paclitaxel-Eluting Balloon Angioplasty for Dysfunctional Hemodialysis Access: A randomized trial Comparing with Angioplasty Alone

PurposeTo assess whether angioplasty of hemodialysis access (HA) stenosis with a drug-coated balloon (DCB) would prevent restenosis in comparison with plain-balloon percutaneous transluminal angioplasty (PTA).Materials and MethodsThis prospective randomized clinical trial enrolled 120 patients with dysfunctional arteriovenous fistulae (n = 109) and grafts (n = 11), due to a ≥50% stenosis between March 2014 and April 2018. All patients underwent high-pressure balloon angioplasty and were then randomized to either DCB (n = 60) or PTA (n = 60). Patients were followed-up for 1 year, and angiography was performed 6 months after angioplasty. The primary endpoint was the late lumen loss (LLL) at 6 months. Secondary endpoints included other angiographic parameters at 6 months and HA failures, adverse event, and mortality at 12 months. Continuous variables were compared with a Student t-test, and Kaplan-Meier curves were used for freedom from HA failure and for mortality.ResultsLLL in the DCB and in the PTA group were 0.64 mm ± 1.20 and 1.13 mm ± 1.51, respectively (P = .082, adjusted P = .0498). DCB was associated with lower percentage stenosis (54.2% ± 19.3 vs 61.7% ± 18.2; P = .047) and binary restenosis ≥50% (56.5% vs 81.1%; P = .009) than PTA. The number of HA failures after 12 months was lower for DCB than for PTA (45% vs 66.7%; P = .017). Mortality at 12 months was 10% and 8.3% in the DCB and PTA groups, respectively (P = .75).ConclusionsDespite LLL improvement that failed to reach statistical significance, this study demonstrated decreased incidence and severity of restenosis with DCB compared with PTA to treat dysfunctional HA.