B.C. Centre for Disease Control researchers develop system used around world to monitor flu vaccine performance

Dr. Danuta Skowronski was on the team that created "test-negative design", or TND

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      When epidemiologist Dr. Danuta Skowronski joined the B.C. Centre for Disease Control, she was reluctant to take on the flu file. Having worked as a medical health officer specializing in communicable disease, she knew the virus was a Pandora’s box. She agreed to work on the influenza portfolio for six months.

      That was 15 years ago, and Skowronski has been studying the highly contagious viral infection ever since. The influenza virus is a classic case of “the more you learn, the less you know,” she explains.

      “I started out doing work on a multitude of different vaccine-preventable diseases,” she says over a latte at a café near the BCCDC in Vancouver, where she is epidemiology lead of influenza and emerging respiratory pathogens. “I knew of all the gaps in knowledge around influenza. There are so many uncertainties, from vaccines to antivirals.…The issues have only grown in terms of prevention and control. The deeper you dig, the more you find there are hidden treasures or hidden bones—things that need to be resolved.

      “It’s a really complex virus,” adds the Winnipeg native, who studied medicine at Queen’s University. “It’s probably the least well controlled of vaccine-preventable diseases. It’s a moving target all the time.”

      Skowronski provides policy advice to provincial, national, and international health bodies. She has witnessed the flu’s effects on the B.C. population at various crisis points over the years: SARS hit in 2003; 2004 was avian influenza in the Fraser Valley; 2005 saw H2N2; and 2009 brought a pandemic.

      “Last year was also quite an exceptional season, with vaccine effectiveness being so low,” she says. “There’s always something happening. As you develop new innovations, you uncover more issues.”

      The world learns from B.C. researchers' work

      The virus may be largely confounding, but under Skowronski’s leadership, B.C. has made tremendous contributions to helping health professionals around the globe understand it.

      Several years ago, Skowronski, a Quebec colleague, and a team of BCCDC virologists—all women—developed what is known as the test-negative design (TND). It’s a form of case-control study that helps monitor flu-vaccine protection, and it was piloted here.

      “We’re part of a global influenza-vaccine-effectiveness network that is using methods that we developed here in B.C.,” Skowronski says. “We had no idea how well the vaccine actually protected every year till we developed test-negative design. It has been adopted by the U.S. CDC [Centers for Disease Control and Prevention] and the ECDC [European Centre for Disease Prevention and Control] and is used by multiple countries worldwide.

      “In the influenza world, it is no exaggeration to say that the TND has revolutionized global capacity to monitor influenza-vaccine performance and has opened our eyes to all sorts of variability in vaccine protection—by age, prior vaccination history, type of influenza virus—that we had been blind to for decades,” she adds. “That’s what I’m most proud of.”

      Skowronski says scientists need imagination

      Skowronski met her husband at Queen’s and moved to Vancouver for his residency. One of four children of a Polish veterinarian father and British artist mother, she studied public health at UBC. Her work in medicine allows her to draw from her dad’s analytical side and her mom’s creative side.

      “My father cultivated my interest in medicine, but to be a good scientist you have to have a lot of imagination, and my mom fostered that,” says Skowronski, an avid reader who is especially fond of Ian McEwan, Mavis Gallant, and Polish poet Wislawa Szymborska.

      She says that although the decision to get a flu vaccine is an individual one, those who are at high risk of complications—which can include hospitalization or death—such as seniors, infants, and people with lung or heart conditions or compromised immune systems, should do whatever they can to prevent getting sick.

      “For most healthy young people, we’re going to fully recover from influenza without any intervention at all,” she says. “But it’s still a miserable illness. What remains certain is that for the high-risk individuals who are facing serious outcomes, the vaccine will provide protection. Even modest protection is important in that context.

      “My patients are the population of B.C.,” she adds. “That’s what you choose when you go into public health. When we’re making decisions, those decisions affect hundreds and thousands of people. It’s clinical practice writ large. You have to be very thoughtful in this role. You also have to be skeptical and questioning.”