Julie Bettinger

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Research Classification

Research Interests

Infectious diseases
Health Promotion
Community Health / Public Health
Infectious disease epidemiology
vaccine clinical trials
Vaccine hesitancy
vaccine programs
vaccine safety

Relevant Degree Programs

Affiliations to Research Centres, Institutes & Clusters



I am a vaccine safety scientist at the Vaccine Evaluation Center, a leading center for applied vaccine research in Canada. My research interests include vaccine safety, vaccine hesitancy and vaccine preventable diseases, as well as attitudes and beliefs around immunization uptake and use. I am also the epidemiologist for the Immunization Monitoring Program, Active, a national surveillance system for vaccine preventable diseases and vaccine adverse events in 12 pediatric tertiary care centers across Canada and the lead investigator for the Canadian National Vaccine Safety (CANVAS) network, an active surveillance network that monitors the safety of vaccines.

Research Methodology


Postdoctoral Fellows

Graduate Student Supervision

Doctoral Student Supervision

Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.

Do fathers care? Measuring mothers’ and fathers’ perceptions of fathers’ involvement in caring for young children in South Africa (2017)

Fathers can be an important source of support for children. However, in South Africa, many children do not reside with their biological father and little is known about fathers’ involvement in children’s care. A questionnaire that reliably measures fathers’ involvement and is adaptable to varied residential arrangements would facilitate future population-level research. We explored whether children who reside with their biological father have better health than children whose fathers live elsewhere. We also assessed whether a questionnaire adapted from surveys in the United States would reliably measure South African fathers’ involvement in caring for infants. With data from the 1998 Demographic and Health Survey, we used multilevel logistic regression to estimate associations between father-child co-residence status and four child health outcomes: breastfeeding for ≥6 months; immunization completeness; recent acute respiratory infection; and recent diarrhea. We found that children with non-co-resident fathers were not at higher risk of these health outcomes. As part of a separate longitudinal cohort study in the Western Cape, we had a sample of mothers complete questionnaires about their infants’ fathers’ care involvement when infants were 2 weeks, 16 weeks and 6 months old. Using Item Response Theory models we estimated the distribution of the fathers’ levels of involvement in five hypothetically distinct modes of care. We used total information functions to assess the precision of father involvement estimates. Most fathers were reportedly spending time with infants, doing routine care activities and providing financially. Fewer fathers were involved in important care decisions or doing household chores. For most fathers in the sample, the questionnaire gave precise estimates of involvement in three modes of care: Accessibility, Direct Caregiving, and Practical Support for Mother. In contrast, items measuring Material Provisioning and Responsibility gave imprecise estimates for the majority of fathers. Our findings reinforce existing evidence that co-residence status is an inadequate proxy for care involvement. Future population-level research into fathers’ influences on children’s health should directly measure fathers’ care practices. With further validation, the questionnaire assessed in this study could be used to measure the more direct modes of infant care.

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The pattern and pathways of infectious morbidity in South African HIV exposed uninfected infants (2016)

Background: Universal infant morbidity risk factors (poor birth outcomes, suboptimal breastfeeding, poverty) occur more frequently in HIV exposed uninfected (HEU) than HIV unexposed uninfected (HUU) infants. HEU infants’ unique exposures, including in utero exposure to HIV products and maternal immune compromise, may potentiate HEU infants’ infectious morbidity risk. The primary objective was to determine whether HEU infants experience greater infectious morbidity than HUU infants through HIV exposure-specific pathways beyond universal infant morbidity risk factors. Methods: This prospective cohort study identified low risk HIV-infected and HIV-uninfected mothers and their term newborns from a single community midwife unit in Kraaifontein, South Africa. The primary outcome, at least one infectious cause hospitalization or death before six months of age, was classified according to modified WHO case-definitions and compared between HEU and HUU infants. Complete outcome determination on all infants was possible through linkage with the electronic provincial hospital administration system and mortality registry. Adjusted odds ratios (aOR) were calculated by multivariable logistic regression including stratified analyses conditioned on breastfeeding. Results: One hundred and seventy six (94 HEU, 82 HUU) mother-infant pairs were included. HIV-infected mothers were older (median 27.8 vs. 24.7 years, p
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Master's Student Supervision

Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.

Investigating the association of receipt of seasonal influenza vaccine with occurrence of anesthesia/paresthesia, headaches and generalized convulsive seizures for all ages, Canada 2012/13-2016/17 (2019)

Introduction/background: Concern about adverse events following immunization (AEFI) is frequently cited by both those who receive vaccines and those who decline to receive vaccines. Neurological adverse events are especially concerning. Our aim is to detect associations for occurrence of anesthesia/paresthesia (numbness, tingling, pins and needles, decreased sensation, or burning sensations anywhere in the body), severe headaches, and generalized convulsive seizures (GCS) in the presence and absence of seasonal influenza vaccination.Methods: Data were analyzed from the Canadian National Vaccine Safety Network that annually collects safety data during the seasonal influenza vaccination campaign. Events were self-reported and prevented daily activity, led to absenteeism, or required medical attention. Controls were previous year vaccinees; events in controls were collected prior to the start of influenza vaccination each year. Total sample size for investigating anesthesia/paresthesia was 107,565 from 2012-2016, and 97,420 for investigating severe headaches and GCS from 2013-2016. Multivariable logistic regression was used to determine the association between seasonal influenza vaccination and occurrence of anesthesia/paresthesia or severe headaches adjusted for gender, age group, reporting center, and year. Fisher’s exact test was used to measure risk of occurrence of GCS.Results: 104 (0.10%) participants reported anesthesia/paresthesia; 63 (0.09%) versus 41 (0.11%) in vaccinees and controls, respectively. Severe headaches were reported by 1,361 (1.40%) participants; 907 (1.48%) versus 454 (1.26%) in vaccinees and controls, respectively. Adjusted OR of anesthesia/paresthesia among those with seasonal influenza vaccination was 0.89 (95% CI = 0.60, 1.32), and of severe headaches was 1.21 (95% CI = 1.08, 1.36). No specific vaccine product was associated with this increased risk. Three participants were identified with GCS; difference in proportions between groups was not statistically significant (p = 0.301).Conclusions: Results are reassuring on the safety of seasonal influenza vaccines. Anesthesia/paresthesia was rare (≥ 0.01 and
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News Releases

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