Pediatric Studies
Safety and immunogenicity of COVID-19 vaccines in pediatric autoimmune diseases (SUCCEED KIDS)
Rae S. M. Yeung, Hospital for Sick Children (SickKids) Research Institute
Children with autoimmune diseases such as inflammatory bowel disease and childhood arthritis are at significant risk of disease flares in response to immune system triggers, which include infections and vaccines.
Research summary Results Study website View study on 
COVID-19 seroepidemiology among children using retrieved POPCORN site leftover blood samples (CURNLS)
Soren Gantt and Caroline Quach-Thanh, Sainte-Justine University Hospital Centre
This study is the largest serosurvey of children and youth in Canada. Researchers are testing existing blood samples from patients aged 0 to 18 who visit one of 16 hospital emergency departments that are members of the POPCORN network to identify whether they have had COVID-19 and whether they have immunity from infection or vaccination.
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Immune Response in Young ImmunoSuppressed children to COVID-19 vaccination (IRYIS)
Hélène Decaluwe, Université de Montréal
This research is studying the immune response and duration of protection of mRNA-based COVID-19 vaccines in children less than 11 years of age with inherited or treatment-induced immune deficiencies to help determine the number of vaccine doses required for optimal protection in immunocompromised children and guide vaccination recommendations.
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Understanding Immune Responses to SARS-CoV-2 Infection and Vaccination in Children aged 5-11 years: Expansion of existing CITF-supported pediatric studies
Jonathon Maguire, Piush Mandhane, Manish Sadarangani, Elinor Simons, Kate Zinszer, Pediatric Network Study
This study expands on four existing CITF-supported pediatric studies to comprehensively address questions related to adaptive immune responses to SARS-CoV-2 infection and vaccination in children aged 5 to 11 years old.
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Active surveillance for COVID-19 vaccine safety and effectiveness among Canadian children: A Canadian Immunization Monitoring Program ACTive (IMPACT) Project
Karina Top and Shaun Morris, Dalhousie University / Canadian Pediatric Society
This study aims to track the safety and effectiveness of COVID-19 vaccines in children and youth as they become approved for use in this age group. Researchers are also studying whether vaccination is linked to fewer children and adolescents being admitted to hospital for COVID-19 and fewer cases of the disease overall.
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Rapid research in the CHILD Cohort to inform Canada’s response to the COVID-19 pandemic
Meghan Azad and Padmaja Subbarao, University of Manitoba
Building off the CHILD Cohort Study which tracks 3,500 families in British Columbia, Alberta, Manitoba, and Ontario, this study aims to provide real-time data to public health authorities about infection, symptoms, transmission, and immunity in 12,000 Canadians (CHILD children, siblings, parents) in these four provinces.
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The TARGet Kids! COVID-19 study of children and families: Safe return to school, work, and play
Jonathon Maguire, Unity Health Toronto
This study pivots TARGet Kids! — Canada’s largest ongoing children’s study — to focus on gathering high-quality, real-time data to monitor, quantify, and characterize COVID-19 infection among children and parents.
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The SPRING Study: SARS-CoV-2 infection in children and young adults in British Columbia
Manish Sadarangani, University of British Columbia
The SPRING Study aims to understand the true rates of SARS-CoV-2 infection in children and young adults in British Columbia, most notably, by including information from children with asymptomatic infection.
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The EnCORE Study: Studying seroprevalence in Montreal school
Kate Zinszer, Université de Montréal
The EnCORE Study is a research project estimating how many young people in Montreal have been infected with SARS-CoV-2. Specifically, they are studying 2- to 17-year-olds in daycares, elementary schools, and high schools randomly selected in four Montreal neighbourhoods.
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A Prospective Pan-Canadian Cohort Assessment of SARS-CoV-2 Variant of Concern Disease Severity and Association with Long-Term Symptoms in Children
Stephen Freedman and Roger Zemek, University of Calgary
This study extends and expands on two ongoing COVID-19 studies to collect acute and long-term data on children. Researchers are following children who test positive and negative for SARS-CoV-2 in emergency departments and will compare whether certain variants lead to a greater disease severity. They will also quantify the development of long-term symptoms (long COVID) in children with COVID-19.
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From idea to reality: COVID-19 Vaccination for Children and Youth
Jonathon Maguire and Catherine S. Birken, Unity Health Toronto
This study builds on work with TARGet Kids! to understand COVID-19 vaccine effectiveness and safety among 2,000 children and youth (0 to 16 years old), and their parents. The team is looking at COVID-19 vaccine uptake and is working to understand COVID-19 vaccine hesitancy and decision-making among parents and healthcare providers in order to inform vaccination policies.
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Post COVID hyperinflammation (MIS-C): A syndrome beyond the name
Rae S. M. Yeung, Hospital for Sick Children (SickKids) Research Institute
Some children who have had COVID-19 infection develop Multisystem Inflammatory Syndrome in Children (MIS-C), an uncontrolled post-COVID-19 inflammation. This study is using machine learning and artificial intelligence strategies to analyze and integrate complex biologic and clinical data in order to rapidly diagnose MIS-C and identify the children at highest risk.
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Optimizing COVID-19 immunization in patients with adverse events following immunization and patients with immunosuppression in the Special Immunization Clinic Network (SIC)
Karina Top, Dalhousie University
The success of mass COVID-19 vaccine campaigns depends on the ongoing evaluation of both the safety and effectiveness of the vaccines. This study aims to support public health agencies in standardizing the evaluation and management of patients with unexpected, severe and serious rare adverse events following immunization (AEFIs) to COVID-19 vaccines.
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COVID-19 lockdowns may be to blame for off-season resurgences of respiratory syncytial virus
Pascal Lavoie, University of British Columbia
This study, an extension of one focussing on education workers in Vancouver, aims to determine how immunity conferred by hybrid immunity differs from the immunity conferred by an infection alone, to compare re-infection rates between individuals with hybrid versus vaccine immunity; and to determine the long-term health impact of SARS-CoV-2 infections among school staff.
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Pascal Lavoie
Pascal Lavoie
Associate Professor, University of British Columbia
Neonatologist, BC Women’s Hospital
Clinician-Scientist, BC Children’s Hospital Research Institute
Contact info
604-875-2135
Key words
Human immunology, Pediatric, Health, Cohort studies
Research interests
- Development of the human, neonatal immune system
- Immunity to common respiratory infections in infants
- Neonatal sepsis biomarkers
- COVID-19 immunity and viral transmission in schools
- Population immunity and cross-reactivity to SARS-CoV-2
Publications
https://pubmed.ncbi.nlm.nih.gov/?term=lavoie%20PM%20and%20covid&sort=date
COVID-19 lockdowns may be to blame for off-season resurgences of respiratory syncytial virus
Where an average of 1,450 cases of respiratory syncytial virus (RSV) are reported each year in British Columbia, only five cases were reported in the province in 2020-2021, due largely to drastically reduced interactions during lockdowns. In a paper published in the Journal of Infectious Diseases, Dr. Pascal Lavoie and his team (University of British Columbia) discovered that infants and women of childbearing age exhibited a profound loss of antibodies against RSV after one year of the COVID-19 pandemic. Natural waning of RSV immunity and lack of exposure to the virus due to pandemic mitigation measures are likely contributors. These results have important implications for the recent resurgences of RSV infections.
Respiratory syncytial virus (RSV) is a viral infection that causes seasonal respiratory illness, particularly in young children and infants. Symptoms include congestion and inflammation of the lungs and upper airways.
Key Findings:
- Antibodies recognizing RSV were roughly 15 times lower in infants sampled in 2021 compared to those sampled in 2020.
- Levels of RSV neutralization were 3.4 times lower in infants sampled in 2021 compared to those sampled the year prior, even after adjusting for age.
- RSV antibody levels in women of childbearing age (18-51 years old) in 2021 were lower compared to those sampled in 2020 but were not meaningfully different to samples retrieved from women sampled in 2018 and 2019.
- RSV antibody neutralization capacities were reduced by 12 times in women sampled in 2021 compared to women sampled in 2020, and significantly lower than those from 2018 and 2019.
- Notably, RSV-specific T cell responses did not differ significantly between 2020 and 2021 in women of childbearing age.
The authors postulate that the decline in RSV antibodies and their reduced ability to neutralize the virus may be due to a combination of the natural waning of immunity over time and the absence of exposure to the virus due to pandemic-related mitigation measures such as school and daycare closures, physical distancing, and mask-wearing. They go on to suggest that ongoing viral exposure may be necessary to maintain immunity to RSV.
Blood samples were collected from women of childbearing age in the first year of the pandemic (February to May 2020) and again in its second year (May to June 2021). Samples were also collected between July and August from infants born after March 31, 2019 (for 2020 samples) and between April and June from infants born after March 31, 2020 (for 2021 samples).
Results: COVID-19 lockdowns may be to blame for off-season resurgences of respiratory syncytial virus
Soren Gantt, MD, PhD, MPH
Professor of Microbiology, Infectious Diseases and Immunology, Université de Montréal
Pediatric Infectious Diseases Consultant, CHU Sainte-Justine
Director of Clinical Research, CHU Sainte-Justine Research Centre
Contact info
soren.gantt@umontreal.ca
Key words
Virology; Pediatrics; Immunology; Vaccines
Research interests
Viral transmission
Congenital infections
Clinical trials
Mathematical modeling
Newborn screening
Publications
Stoddard CI, Sung K, Ojee E, Adhiambo J, Begnel ER, Slyker J, Gantt S, Matsen IV FA, Kinuthia J, Wamalwa D, Overbaugh J, Lehman DA. (2022) Distinct antibody responses to endemic coronaviruses pre-and post-SARS-CoV-2 infection in Kenyan infants and mothers. Viruses 14 (7), 1517.
Tanunliong G, Liu A, Vijh R, Pidduck T, Kustra J, Márquez AC, Choi A, McLennan M, Hayden A, Kearney C, Gantt S, Krajden M, Morshed M, Jassem AN, Sekirov I. Persistence of Anti-SARS-CoV-2 Antibodies in Long Term Care Residents Over Seven Months After Two COVID-19 Outbreaks. Front Immunol. 2021;12:775420. doi: 10.3389/fimmu.2021.775420.
Li FF, Liu A, Gibbs E, Tanunliong G, Marquez AC, Gantt S, Frykman H, Krajden M, Morshed M, Prystajecky NA, Cashman N, Sekirov I, Jassem AN. A novel multiplex electrochemiluminescent immunoassay for detection and quantification of anti-SARS-CoV-2 IgG and anti-seasonal endemic human coronavirus IgG. J Clin Virol. 2022 Jan;146:105050. doi: 10.1016/j.jcv.2021.105050.
Sadarangani M, Raya BA, Conway JM, Iyaniwura SA, Falcao RC, Colijn C, Coombs D, Gantt S. (2021) Importance of COVID-19 vaccine efficacy in older age groups. Vaccine. 2021 Apr 08. https://doi.org/10.1016/j.vaccine.2021.03.020
Abu-Raya B, Gantt S, Sadarangani M. Challenges in evaluating SARS-CoV-2 vaccines during the COVID-19 pandemic. CMAJ. 2020 Aug 24;192(34):E982-E985. doi: 10.1503/cmaj.201237.
COVID-19 seroepidemiology among children using retrieved POPCORN site leftover blood samples (CURNLS)
Our study, titled COVID-19 Seroepidemiology among Children Using Retrieved POPCORN Site Leftover Blood Samples (CURNLS), is the largest serosurvey of children and youth to date in Canada for SARS-CoV-2, and benefits from the network established for the Pediatric Outcomes Improvement through Coordination of Research Networks (POPCORN) study, funded by the Canadian Institutes of Health Research. The POPCORN study brings together pediatric health researchers from 16 hospital research sites across Canada to monitor COVID-19 infections, vaccination, and social impacts among children and youth.
For the CURNLS study, we are testing existing blood samples from patients aged 0 to 18 who visit hospital emergency departments within the POPCORN network sites to identify whether they have had COVID-19 and whether they have immunity from infection or vaccination. At each of five time points over a one-year period, we are collecting and testing approximately 7,200 samples, and analyzing them according to three distinct age groups within the 0 to 18 range.
The information we collect will be combined with contemporaneous rates of transmission, hospitalization, vaccination and use of public health measures to inform public health policy.
Caroline Quach-Thanh
Professor, Dept of Microbiology, infectious diseases and Immunology and Dept of Pediatrics, Université de Montréal
Pediatric Infectious Diseases & Medical Microbiologist, CHU Sainte-Justine
Medical Lead, Infection Prevention & Control, CHU Sainte-Justine
Contact info
c.quach@umontreal.ca
Key words
Vaccines; Epidemiology; Pediatrics; Prevention
Research interests
Vaccine-preventable diseases
Healthcare-associated infections
Infection Prevention
Pediatrics
Public Health
Publications
https://www.ncbi.nlm.nih.gov/myncbi/1H1eawqvwjsczp/bibliography/public/
Hélène Decaluwe
Hélène Decaluwe, MD FRCPC MSc PhD
Associate Professor, Immunology and Rheumatology Division, CHU Sainte-Justine, Department of Pediatrics, Université de Montréal
Contact info
helene.decaluwe@umontreal.ca
Key words
T cells
cytokines
immunodeficiency
immunotherapy
SARS-CoV-2
Research interests
- role of cytokines in the differentiation of T cells in health and disease, and develop novel immunotherapeutic approaches that target cytokine-dependent pathways and inhibitory receptors expressed on T cells
- immune reconstitution of severe combined immunodeficiency patients treated by stem cell transplantation
- T cell immune correlates of protection to SARS-Cov-2
Immune Response in Young ImmunoSuppressed children to COVID-19 vaccination (IRYIS)
While COVID-19 vaccination programs have contributed significantly to protecting Canadians against the SARS-CoV-2 virus, certain groups of people, such as those who are immunocompromised, remain vulnerable to the disease.
There is already some evidence that immune response to COVID-19 infection is hampered in immunocompromised adults, but little is known about how much protection immunocompromised children have. This research project aims to study the immune response of immunosuppressed children to COVID-19 vaccination.
The recommended dose of mRNA vaccines for children 11 years old and younger is less than the dose for adults, so it is critical to investigate if the reduced dose is sufficient to protect children with immune deficiencies from SARS-CoV-2 infection.
Building on the expertise and network developed within the RECOVER studies, which have looked at the immune responses in Quebec healthcare workers infected with SARS-CoV-2 and vaccinated with mRNA vaccines, our researchers are studying the immune response and duration of protection of mRNA-based COVID-19 vaccines in children less than 11 years of age with inherited or treatment-induced immune deficiencies. Our study also includes healthy children (non-immunocompromised) for comparative purposes.
We are following participants for approximately one year and are looking at various factors such as B and T cell immune response, T cell responses to variants of concern, risk of breakthrough infections, viral loads and viral strains of breakthrough infections, and the safety of administered vaccines in immunodeficient and healthy children.
Our study results will help determine the number of vaccine doses required for optimal protection in immunocompromised children and guide vaccination recommendations for public health authorities in Canada.
Omicron breakthrough infection instills higher and more broadly neutralizing immune responses against SARS-CoV-2 variants than a booster dose alone
Manish Sadarangani
Manish Sadarangani, MD, DPhil
Associate Professor, Department of Pediatrics, University of British Columbia
Physician, Division of Infectious Diseases, Department of Pediatrics, BC Children’s Hospital
Director, Vaccine Evaluation Center, BC Children’s Hospital Research Institute
Key words
COVID-19
Children
Antibodies
Transmission
Prevalence
Adolescents and young adults
Research interests
Research links clinical trials with basic microbiology, immunology and epidemiology to address clinically relevant problems related to immunization and vaccine-preventable diseases.
Specific research interests include bacterial vaccines, understanding vaccine-induced immunity, maternal immunization, antibiotic resistance and CNS infections.
Jonathon Maguire
Jonathon Maguire, MD
Associate Professor, Department of Pediatrics, University of Toronto
Dr. Maguire is a scientist with MAP Centre for Urban Health Solutions in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital
Pediatrician, Department of Pediatrics, St. Michael’s Hospital, Unity Health Toronto
University of Toronto Lawson Chair in Patient Engagement in Child Nutrition.
Key words
Child health
Epidemiology
Cohort studies
Social determinants of health
Research interests
Clinical trials involving health and development in young children
Creation of tools to help health-care providers use the best available evidence to inform their clinical decisions.
Piush Mandhane
Piush Mandhane
Associate Professor, University of Alberta
Section Head: Pediatric Respiratory – Stollery Children’s Hospital
Division Head: Pediatric Respiratory – Stollery Children’s Hospital
Contact info
Mandhane@ualberta.ca
Key words
CHILD study
Cohort
Epidemiology
Sleep
Neurodevelopment
Research interests
Sleep and neurodevelopment
Cohort studies
Asthma epidemiology
Understanding Immune Responses to SARS-CoV-2 Infection and Vaccination in Children aged 5-11 years: Expansion of existing CITF-supported pediatric studies
Throughout the pandemic, the global scientific community has focused on understanding the cascade of immune events initiated upon exposure to SARS-CoV-2 and the underlying correlates of protection. Due to the disproportionate impact of SARS-CoV-2 in adults vs. children, there remains a large gap in knowledge regarding immune responses in children. As vaccination has become available to younger age groups, it’s essential to gain a better understanding of immunity to both SARS-CoV-2 infection and response to the vaccines to ensure children’s safe return to a pre-pandemic life.
Our study expands on four existing CITF-supported pediatric studies to comprehensively address questions related to adaptive immune responses to SARS-CoV-2 infection and vaccination in children aged 5 to 11 years old.
The existing studies include TARGet Kids! (Ontario), the CHILD Cohort Study (British Columbia, Alberta, Manitoba, Ontario), the EnCORE Study (Quebec), and the SPRING Study (British Columbia). The collective of these four cohorts allows us to directly assess longitudinal immune responses in children following SARS-CoV-2 infection and/or vaccination.
The expansion study is evaluating quantity and quality of antibody and T cell responses in children previously infected with SARS-CoV-2; comparing antibody and T cell responses to COVID-19 mRNA vaccines in previously uninfected vs. previously infected children; and evaluating kinetics of antibody and T cell responses in children after COVID-19 mRNA vaccination over a 12- to 18-month period. Participants visit their study centre for venous blood and saliva collection at four time points: before COVID-19 vaccination, and at one, six and 12 months after two doses of COVID-19 mRNA vaccine.
Understanding the safety, efficacy and longevity of protection following vaccination, as well as learning about correlates of protection, will help inform pediatric immunization schedules for SARS-CoV-2 vaccines, in-person childcare and learning policies, and other public and social health measures. The study results are being shared with all stakeholders, including PHAC, NACI, CITF and other federal, provincial and territorial public health leaders, as requested.
Elinor Simons
Dr. Elinor Simons
Pediatric Allergist and Clinical Epidemiologist, Children’s Hospital Research Institute of Manitoba
Pediatric Allergist, Children’s Hospital of Winnipeg
Assistant Professor and Section Head of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba
Key words
Food allergy, epidemiology, asthma, CHILD Cohort Study, oral immunotherapy, COVID-19, immunity
Research interests
Epidemiology, development and natural history of food allergy, asthma, and allergic conditions of childhood
CHILD Cohort Study, Manitoba Site Principal Investigator
Long-term immunity to COVID-19 in children
Karina Top
Karina Top, PhD
Associate Professor, Dalhousie University
Pediatric Infectious Disease Consultant, IWK Health
Contact info
Karina.top@dal.ca
Key words
Vaccines
Adverse events following immunization
Epidemiology
Infectious diseases
Pediatrics
Research interests
- Vaccine safety surveillance
- Clinical management of patients who have experienced adverse events following immunization
- Vaccine safety and effectiveness in immune-compromised patients
- Vaccine safety in pregnancy
Shaun Morris
Shaun Morris, PhD
Associate Professor, Department of Paediatrics, Faculty of Medicine, University of Toronto
Clinician-Scientist, Division of Infectious Diseases, Hospital for Sick Children
Contact info
shaun.morris@sickkids.ca
Key words
Paediatrics
Epidemiology
Surveillance
Vaccines
COVID-19
MIS-C
Research interests
COVID-19 in children and adolescents
MIS-C in children and adolescents
SARS-CoV-2 vaccine effectiveness and safety
Publications:
Piché-Renaud PP. Ji C, Farrar DS, Friedman JN, Science M, Kitai I, Burey S, Feldman M, Morris SK. Impact of the COVID-19 pandemic on the provision of routine childhood immunizations in Ontario, Canada. Vaccine 2021. DOI: 10.1016/j.vaccine.2021.05.094
Kitano T, Kitano M, Krueger C, Jamal H, Al Rawahi H, Lee-Krueger R, Sun RD, Isabel S, García Ascaso MT, Hibino H, Camara B, Isabel M, Cho L, Groves H, Piché-Renaud PP, Kossov M, Kou I, Jon I, Jian Z, Blanchard AC, Matsuda N, Mahood Q, Wadhwa A, Bitnun A, Morris SK. A systematic review of COVID-19 global case fatality rate and rate of ICU admission in children. PLOS ONE 16(1): e0246326. https://doi.org/10.1371/journal.pone.0246326
Li J, Tang K, Levin M, Irfan O, Morris SK, Wilson K, Klein JD, Bhutta ZA. COVID-19 infections and Multi-system Inflammatory Syndrome in Children (MIS-C/PIMS-TS) and Adolescents. Lancet Infectious Diseases 2020 Aug 17:S1473-3099(20)30651-4. doi: 10.1016/S1473-3099(20)30651-4.
Piché-Renaud PP, Groves H, Kitano T, Arnold C, Thomas A. Streitenberger L, Alexander L, Morris SK, Science M. Healthcare workers’ perception of a global outbreak of novel coronavirus (COVID-19) and personal protective equipment: Survey of a pediatric tertiary care hospital Infect Control Hosp Epidemiol 2020 Aug 12;1-25. doi: 10.1017/ice.2020.415.
Kirtsman M, Diambomba Y, Poutanen SM, Malinowski AK, Vlachodimitropoulou E, Parks ET, Erdman L, Morris SK, Shah PS. Probable congenital SARS-CoV-2 infection in a neonate born to a woman with active SARS-CoV-2 infection
CMAJ May 2020, cmaj.200821; DOI: 10.1503/cmaj.200821.
Shah PS, Diambomba Y, Acharya G, Morris SK, Bitnun A. Classification system and case definition for SARS‐CoV‐2 infection in pregnant women, fetuses, and neonates. 2020 Apr 11. doi: 10.1111/aogs.13870
Active surveillance for COVID-19 vaccine safety and effectiveness among Canadian children: A Canadian Immunization Monitoring Program ACTive (IMPACT) Project
In children, the rate of serious illness due to COVID-19 infection is low compared to the adult population. Children rarely become critically ill from COVID-19 but there have been cases of multisystem inflammatory syndrome in children (MIS-C) which can occur as a result of COVID-19 infection. Vaccine clinical trials in children and adolescents are generally not large enough to identify rare adverse events after vaccination. Our study, called Active surveillance for COVID-19 vaccine safety and effectiveness among Canadian children: A Canadian Immunization Monitoring Program ACTive (IMPACT) Project, aims to track emergency department visits in pediatric hospitals across Canada to monitor COVID-19 cases in children and youth, and measure the safety and effectiveness of COVID-19 vaccines in this age group.
Through the Canadian Immunization Monitoring Program ACTive (IMPACT), a network comprised of 13 children’s hospitals, we are monitoring pediatric hospital emergency room visits to identify any health events related to COVID-19 infection or vaccination. We are monitoring the symptoms of any children or adolescents admitted to hospital due to COVID-19, including those with MIS-C and myocarditis/pericarditis. We are also tracking the safety and effectiveness of COVID-19 vaccines as they become approved for use in this age group, and studying whether vaccination is linked to fewer children and adolescents being admitted to hospital for COVID-19 and fewer cases of the disease overall. Our study is looking at rates of adverse events over time before and after vaccination, and between vaccinated and unvaccinated children.
This project will provide important information on the safety and effectiveness of COVID-19 vaccines in children and adolescents and will contribute to better understanding COVID-19 prevention and control in this age group.
COVID-19 Vaccine Safety
Meghan Azad
Associate Professor, Pediatrics and Child Health, University of Manitoba
Research Scientist, Children’s Hospital Research Institute of Manitoba
Manitoba Co-Lead, CHILD Cohort Study
Contact info
Meghan.Azad@umanitoba.ca
@MeghanAzad
www.azadlab.ca
Key words
CHILD Cohort Study
Children
Pediatrics
COVID-19 pandemic
Psychosocial
Serology
Wellbeing
Mental health
Research interests
Developmental Origins of Chronic Disease
Breastfeeding
Human Milk
Microbiome
Perinatal Health
Padmaja Subbarao
Associate Professor, Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto
Associate Professor, Department of Pediatrics & Physiology, Faculty of Medicine, University of Toronto
Assistant Professor, Cross Appointment Research, Division of Respirology, Department of Medicine, McMaster University
Staff Physician/Respirologist
Senior Scientist, Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children
Associate Staff Physician, Department of Paediatrics, Division of Neonatology, Mount Sinai Hospital
Director, CHILD Cohort study
Co-Lead, Precision Child Health, The Hospital for Sick Children
Key words
Asthma
Wheeze phenotypes
Atopic phenotypes
Lung function
Microbiome
Birth cohort study
Translational epidemiology
Research interests
Developmental origins of chronic disease in general population cohorts.
Development of asthma and lung health.
Severe asthma (in particular preschool severe asthma)
Publications
Subbarao P, Anand SS, Becker AB, Befus AD, Brauer M, Brook JR, Denburg JA, HayGlass KT, Kobor MS, et al, Sears MR and the CHILD Study investigators. The Canadian Healthy Infant Longitudinal Development (CHILD) Study: examining the developmental origins of asthma and allergy. Thorax. 2015 Oct;70(10):998-1000.
Direct and indirect impacts of the COVID-19 pandemic on Canadian families
We also do not know why some infected people get sick and others do not, and we do not know the true rates of infection. These questions must be answered quickly to control outbreaks and minimize the unintended consequences of pandemic management policies.
The CHILD Cohort Study tracks 3,500 families in British Columbia, Alberta, Manitoba, and Ontario, who have been followed since before their children were born between 2008 and 2010. In 2018-2020 (just before the pandemic), children in our study provided detailed health data and blood samples. This gives us a unique opportunity to study how children’s pre-pandemic health and immune status influences the risk and outcome of coronavirus infection.
Our study involves requesting all our CHILD family members to report COVID-19 symptoms, using a text messaging system, as well as provide a few drops of blood for antibody testing, using a simple at-home kit. Families will also complete surveys about their physical and mental health, vaccinations, behaviours, and emotions during the pandemic.
Our research will provide real-time data to public health authorities about infection, symptoms, transmission, and immunity in 12,000 Canadians (CHILD children, siblings, parents) in four provinces, which will better inform Canada’s COVID-19 response.
Results: Direct and indirect impacts of the COVID-19 pandemic on Canadian families
Results: Safe return to school, work, and play: The TARGet Kids! COVID-19 study of children and families
Safe Return to School, Work, and Play: The TARGet Kids! COVID-19 Study of Children and Families
Across Canada and around the world, governments have implemented policies to limit the spread of COVID-19, such as physical distancing and school and childcare closures. Many governments are reducing these measures and returning children and families to school and work, due to social, economic, and political factors.
The World Health Organization recommends that governments seeking to relax physical isolation measures do so through two complementary approaches: 1) break chains of transmission by testing, isolating, and treating; and 2) monitor disease circulation through serological surveys.
Our study pivots TARGet Kids! — Canada’s largest ongoing children’s study — to focus on gathering high-quality, real-time data to monitor, quantify, and characterize COVID-19 infection among children and parents.
We are measuring COVID-19 serology among Canadian children and their parents to understand risk factors for infection, disease severity, health system use, and how COVID-19 is transmitted between children and their parents.
We are also answering important questions about the impact of physical distancing policies on child emotional and behavioral health and parent mental health.
Our study will provide evidence to support policy interventions to break under-recognized chains of transmission, reduce illness severity, and minimize unintended harms on children’s health and wellbeing. This will help policy makers guide children and their parents in safely returning to school, work, and play.
From idea to reality: COVID-19 Vaccination for Children and Youth
While serious COVID-19 acute illness in children is rare, it can occur, underscoring the importance of vaccinating children and youth against COVID-19. Children and youth represent 21% of the Canadian population so vaccinating them against COVID-19 is necessary for population-wide immunity. Among children and youth, further research into vaccine immune response, side effects, and degree of protection for future COVID-19 infection is still needed. In addition, there is also the issue of parents and healthcare providers’ perceptions of vaccinating healthy children and youth against COVID-19.
In April 2020, we directed TARGet Kids!, Canada’s largest ongoing children’s cohort study, to understand the effects of COVID-19 on Canadian children and families. We have been following over 1,000 children to understand SARS-CoV-2 infection and symptoms, risk factors for infection, physical and mental health status and seroprevalence among children and their parents.
We are building upon this work to understand COVID-19 vaccine effectiveness and safety among 2,000 children and youth (0 to 16 years old), and their parents. We are also looking at COVID-19 vaccine uptake and working to understand COVID-19 vaccine hesitancy and decision-making among parents and healthcare providers. Rapid evaluation with a specific focus on children, youth and their parents will provide high-quality evidence to guide family-based policy interventions for COVID-19 vaccination for children.
This study, called From idea to reality: COVID-19 Vaccination for Children and Youth, will provide needed information to inform vaccination policies. It will also provide confidence about COVID-19 vaccine effectiveness and safety for children and youth, and contribute to a high degree of vaccine uptake so that society can return to normal functioning.
Results: From idea to reality: COVID-19 Vaccination for Children and Youth
The SPRING Study: SARS-CoV-2 infection in children and young adults in British Columbia
We are also looking at infection rates among university-aged people, a group that has seen a significant increase in COVID-19 cases in certain provinces.
Our study involves approximately 2,500 participants, aged 0 to 24 years, who live in BC. Participation requires a consent form, an online questionnaire, and a home finger-prick blood test (or a heel prick for infants). Researchers will inform participants if they have antibodies to SARS-CoV-2 (although that does not guarantee immunity).
Our study is part of a network of pediatric-focused surveys measuring SARS-CoV-2 seroprevalence in younger populations. Three others are taking place in Manitoba, Ontario, and Quebec.
Our results will be used to:
- Establish the current age- and sex-specific seroprevalence of SARS-CoV-2 and changes to it over 12 months of the pandemic;
- Determine changes in antibody levels;
- Define asymptomatic infection rates to support predictive modelling in BC and Canada; and
- Model different policy scenarios for maintaining or relaxing physical distancing measures.
Understanding infection rates and how these change over time will help public health authorities make informed decisions with regards to public health measures for this age group.
Results: The SPRING Study: SARS-CoV-2 infection in children and young adults in British Columbia
Kate Zinszer
Assistant Professor, University of Montreal
Researcher, Center for Public Health Research
Key words
Epidemiology
Infectious diseases
Serology
Global health
Disease surveillance
COVID-19
Vector-borne diseases
Spatio-temporal models
Heath equity
Research interests
Research program focuses on infectious diseases in Canada and in low- and middle-income countries.
Current projects include COVID-19 seroprevalence in Montreal, forecasting future burdens of vector-borne disease according to different climate change scenarios, and evaluating large-scale public health interventions.
The EnCORE Study: How many children and teens in Montreal have been infected with SARS-CoV-2?
Recent Canadian surveys have uncovered detrimental impacts of confinement, which have affected young people’s emotional, behavioural, and psychological wellbeing. Through the questionnaire portion of this study, our research will estimate the prevalence of emotional and mental health difficulties among children and teens within these neighbourhoods.
Participation requires a consent form, an online questionnaire, and a home finger-prick blood test. Researchers will inform parents if their child has antibodies to SARS-CoV-2 (although that does not guarantee immunity against the virus).
Our study is part of a network of paediatric-focused surveys measuring SARS-CoV-2 seroprevalence in younger populations. Three others are taking place in British Columbia, Manitoba, and Ontario.
Our primary objectives are to:
- Estimate the seroprevalence of SARS-CoV-2 in children in Montreal, representative of age groups;
- Compare the seroprevalence of SARS-CoV-2 in children in different neighbourhoods of Montreal; and
- Estimate the risk of seroconversion of SARS-CoV-2 in children in Montreal from the beginning to the end of the school year.
Our results will allow us to better understand how much virus transmission has occurred, as well as inform decision-making around prevention strategies in neighbourhoods, schools, and daycares. Our research seeks to contribute to targeted measures that will balance the impacts of COVID-19 with the consequences of confinement measures.
Results: The EnCORE Study: How many children and teens in Montreal have been infected with SARS-CoV-2?
Catherine S. Birken
Catherine S. Birken, MD MSc FRCPC
Professor, Department of Paediatrics, University of Toronto
Staff Physician, Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children
Senior Scientist, Child Health Evaluative Sciences, Hospital for Sick Children, Research Institute
Contact info
catherine.birken@sickkids.ca
Key words
child obesity, child health, screen time and physical activity, cardiometabolic risk, evidence-based medicine, school outcomes
Research interests
Prevention of childhood overweight and obesity
Preconception health in women and their partners; impact on child growth and development
Improving child health behaviours and readiness for school
Publications
Li X, Vanderloo LM, Maguire JL, Keown-Stoneman CDG, Aglipay M, Anderson LN, Cost KT, Charach A, Vanderhout SM, Birken CS; TARGet Kids! Collaboration. Public health preventive measures and child health behaviours during COVID-19: a cohort study. Canadian Journal of Public Health 2021 Jul 7:1-11. Published Online. https://doi.org/10.17269/s41997-021-00549-w
Cost KT, Crosbie J, Anagnostou E, Birken CS, Charach A, Monga S, Kelley E, Nicolson R, Maguire JL, Burton CL, Schachar RJ, Arnold PD, Korczak DJ (2021). Mostly worse, occasionally better: impact of COVID-19 pandemic on the mental health of Canadian children and adolescents. European Child & Adolescent Psychiatry (Epub ahead of print) doi.org/10.1007/s00787-021-01744-3
Yoshida-Montezuma Y, Keown-Stoneman CGD, Wanigaratne S, Li X, Vanderhout SM, Borkhoff CM, Birken CS, Maguire JL, Anderson LN. The social determinants of health as predictors of adherence to public health preventive measures among parents and young children during the COVID-19 pandemic: a longitudinal cohort study. Canadian Journal of Public Health (2021) 112:552–565.
Stephen Freedman
Stephen Freedman
Alberta Children’s Hospital Foundation Professor in Child Health and Wellness & Professor of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary
Pediatric Emergency Medicine Physician, Alberta Children’s Hospital
Administrative title and affiliated institution
Contact info
stephen.freedman@ahs.ca
Key words
Pediatrics
Emergency Medicine
COVID-19
SARS-CoV-2
Vomiting
Diarrhea
Anti-emetics
Dehydration
Rehydration
Ondansetron
Research interests
COVID-19
Acute gastroenteritis
Clinical trials
Patient reported outcomes
Publications
Protecting Canada’s children from the consequences of the fourth wave of the COVID-19 pandemic.
Freedman SB, Kellner JD.CMAJ. 2021 Sep 27;193(38):E1500-E1502. doi: 10.1503/cmaj.211513.PMID: 34580150
Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments: A Nationwide Study.
Finkelstein Y, Maguire B, Zemek R, Osmanlliu E, Kam AJ, Dixon A, Desai N, Sawyer S, Emsley J, Lynch T, Mater A, Schuh S, Rumantir M, Freedman SB; Pediatric Emergency Research Canada (PERC).Pediatr Emerg Care. 2021 Aug 1;37(8):427-434. doi: 10.1097/PEC.0000000000002484.PMID: 34074990
Prospective cohort study of children with suspected SARS-CoV-2 infection presenting to paediatric emergency departments: a Paediatric Emergency Research Networks (PERN) Study Protocol.
Funk AL, Florin TA, Dalziel SR, Mintegi S, Salvadori MI, Tancredi DJ, Neuman MI, Payne DC, Plint AC, Klassen TP, Malley R, Ambroggio L, Kim K, Kuppermann N, Freedman SB.BMJ Open. 2021 Jan 15;11(1):e042121. doi: 10.1136/bmjopen-2020-042121.PMID: 33452195
Roger Zemek
Professor, Dept. of Pediatrics and Emergency Medicine, University of Ottawa
Senior Scientist, Children’s Hospital of Eastern Ontario (CHEO) Research Institute
Clinical Research Chair in Pediatric Concussion, uOttawa Brain and Mind Research Institute
Pediatric Emergency Medicine Physician, Children’s Hospital of Eastern Ontario
Director, Clinical Research Unit, CHEO RI
Contact info
rzemek@cheo.on.ca
Key words
Pediatrics
Emergency Medicine
COVID-19
SARS-CoV-2
Concussion
Physical activity
Mental health
Asthma
Research interests
COVID-19
Concussion
Asthma
Clinical trials
Publications
Finkelstein Y, Maguire B, Zemek R, Osmanlliu E, Kam AJ, Dixon A, Desai N, Sawyer S, Emsley J, Lynch T, Mater A, Schuh S, Rumantir M, Freedman SB; Pediatric Emergency Research Canada (PERC). Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments: A Nationwide Study. Pediatr Emerg Care. 2021 Aug 1;37(8):427-434. doi: 10.1097/PEC.0000000000002484. PMID: 34074990; PMCID: PMC8327936.
Reid S, Bhatt M, Zemek R, Tse S. Virtual care in the pediatric emergency department: a new way of doing business? CJEM. 2021 Jan;23(1):80-84. doi: 10.1007/s43678-020-00048-w. Epub 2020 Dec 18. PMID: 33683615; PMCID: PMC7747474.
Rae S. M. Yeung
Professor, Departments of Paediatrics, Immunology and Institute of Medical Science, University of Toronto
Staff Physician and Senior Scientist, The Hospital for Sick Children
Contact info
Rae.yeung@sickkids.ca
Key words
MIS-C (multisystem inflammatory syndrome in children)
Hyperinflammation
Kawasaki disease
COVID-19
Biomarkers
Cytokines
Machine learning
Research interests
Precision medicine
Cytokine storm syndrome
Autoimmunity
Publications
Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, Behrens EM, Ferris A, Kernan KF, Schulert GS, Seo P, Son MBF, Tremoulet AH, Yeung RSM, Mudano AS, Turner AS, Karp DR, Mehta JJ: Clinical guidance for pediatric patients with Multisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 and hyperinflammation in COVID-19. Version 3. Arthritis and Rheumatology 2021: 73:e13-e29.
Henderson LA, Yeung RSM: MIS-C: early lessons from immune profiling. Nature Reviews Rheumatology 2021:17(2):75-76.
Yeung RSM, Ferguson PJ: Is multisystem inflammatory syndrome in children on the Kawasaki syndrome spectrum? Journal of Clinical Investigation. 2020: 130(11):5681-5684.
Tam H, El Tal T, Go E, Yeung RSM: Pediatric inflammatory multisystem syndrome temporally associated with COVID-19: a spectrum of diseases with many names. Canadian Medical Association Journal. 2020: 192(38):E1093-E1096.
A Prospective Pan-Canadian Cohort Assessment of SARS-CoV-2 Variant of Concern Disease Severity and Association with Long-Term Symptoms in Children
In general, SARS-CoV-2 infection in children is milder than what occurs in adults, however there is still a small percentage of children with COVID-19 who have been hospitalized, with some being admitted to intensive care units. Since the wild type (original strain) appeared in December 2020, several SARS CoV-2 variants of concern (VOC) have emerged that either spread more easily and/or cause more severe outcomes. The presence of these VOCs in Canada presents an urgent need to understand their short- and long-term impacts on children, particularly since children are the last age group to be vaccinated in Canada and vaccination levels among children are lower, meaning they are most likely to be exposed to infection.
There is a growing body of data indicating that some individuals with COVID-19 develop persistent symptoms that are characteristic of long-term COVID symptoms, including fatigue, headache, shortness of breath, cognitive impairment, depression, skin rashes and gastrointestinal complaints. Data on long-COVID in children, however, are scarce.
To address these knowledge gaps, we are extending and expanding two ongoing COVID-19 studies to collect acute and long-term data on children. In this study called A Prospective Pan-Canadian Cohort Assessment of SARS-CoV-2 Variant of Concern Disease Severity and Association with Long-Term Symptoms in Children, we are following both SARS-CoV-2 positive (VOC and non-VOC) and negative children who are tested in emergency departments to enable comparisons across pathogens and SARS-CoV-2 strains to clarify the severity of disease in children. We will also quantify the development of long-term symptoms in children with COVID-19 with up to a 12-month follow-up.
A Prospective Pan-Canadian Cohort Assessment of SARS-CoV-2 Variant of Concern Disease Severity and Association with Long-Term Symptoms in Children
Post COVID hyperinflammation (MIS-C): A syndrome beyond the name
A number of children who have had COVID-19 infection develop Multisystem Inflammatory Syndrome in Children (MIS-C), an uncontrolled post-COVID-19 inflammation. MIS-C can develop weeks after a mild or even asymptomatic COVID-19 infection, and during the pandemic, hospitals have been seeing children in shock and with heart failure due to MIS-C.
MIS-C closely resembles Kawasaki Disease (KD) which causes fever and inflammation of blood vessels, most importantly the coronary arteries which feed the heart. It is therefore critical for healthcare teams to quickly identify high-risk children with MIS-C in order to control the inflammation before it damages the child’s heart.
Our team has extensively researched the reasons for inflammation leading to shock and hyperinflammation in KD and we have identified key biological markers (biomarkers) and optimal targets for treatment. These discoveries have been rapidly translated to patient care, resulting in new medications and improved outcomes for patients. Our goal is to transfer this knowledge to treating children with MIS-C and provide much-needed evidence to guide development of effective therapeutic approaches.
Our study is using machine learning and artificial intelligence strategies to analyze and integrate complex biologic and clinical data in order to rapidly diagnose MIS-C and identify the children at highest risk. We have a strong Canada-wide team, with expertise and an infrastructure in place from our other successful projects and national networks. We also have international partner networks across Europe and the US and will share our results widely to benefit as many children as possible.
Safety and immunogenicity of COVID-19 vaccines in pediatric autoimmune diseases (SUCCEED KIDS)
Determining vaccine safety and efficacy in children and youth with autoimmune diseases
Children with autoimmune diseases such as inflammatory bowel disease and childhood arthritis are at significant risk of disease flares in response to immune system triggers, which include infections and vaccines. These children also commonly take medications that suppress their immune system which may decrease the formation of protective antibodies. Ensuring their safety and protection against SARS-CoV-2 infection is critical. Our study aims to determine if COVID-19 vaccines are as safe and effective for children and youth with autoimmune disease as they are for children and youth without autoimmune disease.
Our research team is using different methods to study the immune response in children with autoimmune disease. We analyze administrative hospital records, as well as patients’ self-reported data gathered through questionnaires and phone calls to collect information on outcomes related to disease flares, as well as vaccine effectiveness and safety. In addition, participants are using dried blood spot (DBS) kits to help us determine antibody-related outcomes.
Our study participants are children (any age) on immunosuppressive treatment for autoimmune diseases, who are receiving COVID-19 vaccines authorized for pediatric populations in Canada. We are looking at primary outcomes of autoimmune disease flares and neutralizing antibody levels, and comparing them to children who do not have autoimmune disease.
Our study approach is harmonized with a partner study funded by the CITF on COVID-19 vaccines in adults with autoimmune diseases, which allows us to compare and evaluate similarities and differences in adult versus pediatric populations.
