CANADA regular flu vax - Fluviral S/F - ID Biomedical (Shire)

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CANADA - Fluviral S/F - ID Biomedical (Shire)

Interesting CDC says 36,000 in US (and previous

emails show you how inflated that number is)

Canada says

" The number of deaths attributable to the flu and

its complications varies yearly. It is estimated

that, on average, between 500 and 1500 Canadians

die from the flu or flu related complications every year 1. "

http://www.phac-aspc.gc.ca/im/influenza-eng.php

http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/08vol34/acs-3/index-eng.php

Several influenza vaccines that are currently

marketed in Canada contain minute quantities of

thimerosal, which is used as a preservative(98).

One thimerosal-free vaccine (Influvac™, Solvay

Pharma), approved for persons 18 years of age, is available in Canada(98).

http://pharmalive.com/News/index.cfm?articleid=576680

With 25 mcg of Mercury

Production of influenza vaccine this year was

complicated by the introduction of three new

influenza strains for the 2008-2009 season:

A/Brisbane/59/2007 (H1N1)-like strain,

A/Brisbane/10/2007 (H3N2)-like strain and

B/Florida/4/2006-like strain. Fortunately, this

factor did not result in any delays in delivering doses for the season.

About FLUVIRAL®

FLUVIRAL® conforms to the current

requirements of the World Health Organization

(WHO). FLUVIRAL®, split-virion influenza

vaccine, is used for active immunization against

influenza disease caused by the influenza

subtypes A and type B contained in the vaccine.

FLUVIRAL® is indicated for the active

immunization against influenza caused by

influenza virus in adults and children 6 months of age or older.

GlaxoKline: A Canadian Vaccines Leader

GlaxoKline is the leading Canadian influenza

vaccine manufacturer, and will supply the

majority of the Canadian government's seasonal

influenza vaccines purchases until 2010

Fluviral S/F

Produced and commercialized in Canada by ID Biomedical

Fluviral S/F:

influenza virus vaccine trivalent, inactivated split-viron prepared in eggs.

The number of deaths attributable to the flu and

its complications varies yearly. It is estimated

that, on average, between 500 and 1500 Canadians

die from the flu or flu related complications every year 1.

Vaccination is the most effective way to protect

people from the influenza. With a good match

between the strains in the vaccine and those in

circulation, influenza vaccination has been shown

to prevent laboratory-confirmed influenza illness

in approximately 70% to 90% of healthy children and adults 2.

Efficacy for the higher risk segment

High risk groups (patients with cardiac or

pulmonary disorders, diabetes renal disease,

cancer, immunosuppression, anemia,

hemoglobinopathy), and persons aged 65, or over,

and any resident of a nursing home are at

particular risk as the occurrence of severe

complication, even mortality, is significantly

higher in this subset of the population.

Vaccination in this segment is of great

importance since it can save many lives.

Pandemic

ID Biomedical has been chosen by the government

of Canada to assure a state of national readiness

in case of an influenza pandemics and to provide

influenza vaccine for all Canadians if such an

event were to happen. Canada is one of the few

countries in the world that has such a program in place.

Influenza pandemics occur infrequently, but when

they do they can have severe and lethal

consequences. There have been three in the

twentieth century: in 1918, 1957, and 1968. The

Spanish flu pandemic in 1918 claimed more than 20 million lives worldwide.

Each year, the World Health Organization

identifies the most relevant flu strains for

worldwide vaccine production and recommends which

strains should be incorporated into the annual

vaccine. However, an entirely different strain of

flu can periodically emerge. Only the rapid

production of a new vaccine can provide protection for the population.

Creating a state of readiness in Canada requires

the development of sufficient infrastructure and

capacity to provide influenza vaccine for 100% of

domestic vaccine needs in the event of an influenza pandemic.

1 www.hc-sc.ca Health Canada Influenza Information Sheet. October 2002

2 National Advisory Committee on Immunization

(NACI ), Statement on influenza vaccination for

the 2003- 2004 season, Canada Communicable

Disease Report Volume 29 ACS-4 15 August 2003

*******

from 2005/2006 (couldn't find this years, but

usually no changes other than strains)

http://www.phb.ca/influenza/UIIP2005-2006/UIIP%20Package/PDF%20files%20-%20Engli\

sh/Monographs/Fluviral_E.pdf

(this is a PDF and this is copy of the text so formatting is not very good)

BELOW are

1. The Strains included in this years

2. Formaldehyde

3. grown on hen's eggs

4. thimerosal - The vaccine also contains 0.01% thimerosal as a preservative,

5. sodium deoxycholate (what I can glean is that

this is a bile salt that is used as a detergent

and can dissolve cell membranes)

FLUVIRAL ® (2005-2006)

INFLUENZA VIRUS VACCINE

TRIVALENT, INACTIVATED SPLIT-VIRION PREPARED IN EGGS

For active immunization against influenza.

Strains: A/New Caledonia/20/99

A/New York/55/2004

B/Jiangsu/10/2003

Inactivated with formaldehyde

DESCRIPTION

FLUVIRAL ® , is a trivalent, split-virion

influenza vaccine prepared from virus grown in the

allantoic cavity of embryonated hens' eggs. The

virus is inactivated with ultraviolet light

treatment followed by formaldehyde, purified by

centrifugation and disrupted with sodium

deoxycholate. FLUVIRAL ® is used for active

immunization against influenza strains A/New

Caledonia/20/99, A/New York/55/2004 and B/Jiangsu/10/2003.

CAFV08/PI 8.11 approved A/New York/55/2004

B/Jiangsu/10/2003

Keep between 2 °C and 8 °C

DIN 02015986

HEALTH PROFESSIONAL INFORMATION

Strength

Clinically Relevant Nonmedicinal

Ingredients

15 µg influenza virus

Haemagglutinin/strain/

0.5 mL dose

INDICATIONS AND CLINICAL USE

FLUVIRAL®, split-virion influenza vaccine, is

indicated for the active immunization against

influenza strains A/New Caledonia/20/99, A/New

York/55/2004 and B/Jiangsu/10/2003. The

National Advisory Committee on Immunization (CCDR, June 15, 2004) recommends

administration of influenza vaccines to the following groups:

oAdults and children with:

ochronic cardiac or pulmonary disorders (including bronchopulmonary dysplasia,

cystic fibrosis and asthma) severe enough to require regular medical follow-up

CAFV08/PI 8.11 approved or hospital care; chronic

cardiac and pulmonary disorders in persons over the age

of 45 are by far the most important risk factors

for influenza-related mortality;

oother chronic conditions such as diabetes and

other metabolic diseases, cancer,

immunodeficiency (including HIV infection) or immunosuppression, renal

disease or hemoglobinopathy and anaemia.

oResidents of nursing homes and other chronic care facilities.

oPeople over 65 years of age.

o Healthy persons aged 6 months to 64 years.

oChildren and adolescents (aged 6 months to 18

years) with conditions treated for

long periods with acetylsalicylic acid.

oPersons infected with human immunodeficiency virus (HIV).

oPeople capable of transmitting influenza to those at high risk of developing

influenza-related complications, including the following:

oHealth care providers who work in facilities and community settings, such as

physicians, nurses, and emergency response workers;

oHealth care and other service providers who have contact with residents of

continuing care facilities or residences;

oThose who provide home care for persons in high-risk groups;

oThose who provide services within closed or

relatively closed settings to persons

at high risk;

oHousehold contacts (adults and children) of people at high risk of influenza

complications (including contacts of children <6 months and children 6 to 23

months) as well as pregnant women expected to deliver during influenza season;

oThose providing regular childcare to children

aged 0 to 23 months, whether in or

out of the home;

oPeople who provide essential community services.

oPregnant women in high-risk groups.

oPeople at high risk of influenza complications embarking on foreign travel to

destinations where influenza is likely to be circulating.

oHealthy working adults (employers and their employees).

oPeople in direct contact with poultry infected

with avian influenza during culling

operations.

Pediatrics: Healthy children aged 6 to 23 months

are at increased risk of influenza-associated

hospitalization compared with healthy older

children and young adults. Children and

adolescents (aged 6 months to 18 years) treated

for long periods with ASA may be at increased

risk of Reye Syndrome after influenza infection.

Geriatrics (=65 years of age): The risk of severe

morbidity and mortality related to influenza

is moderately increased in healthy persons over

65 years of age but is not nearly as great as in

persons with chronic underlying disease.

HIV-Infected Persons: Limited information exists

regarding the frequency and severity of

influenza illness among HIV-infected persons, but

reports suggest that symptoms may be

prolonged and the risk for complications

increased for some HIV-infected persons. Because

influenza can result in serious illness and

complications, vaccination is a prudent precaution and

will result in protective antibody levels in many

recipients. However, the antibody response to

vaccine may be low in persons with advanced

HIV-related illnesses; giving a second dose of

vaccine 4 or more weeks after the first does not

improve the immune response for these

persons. Further studies are also required to

determine whether influenza immunization can

adversely affect patients infected with HIV. To

date, some studies indicate that influenza

immunization can be associated with transient

increases in plasma HIV concentration, but no

study has demonstrated an adverse effect of this

temporary change on HIV disease progression.

Pregnant women: Vaccination is recommended for

pregnant women in high-risk groups (see

above section). Vaccine is considered safe for

pregnant women - regardless of their stage of

pregnancy. Although excess morbidity and

mortality were observed among pregnant women

during the pandemic outbreaks in 1918-19 and

1957-58, further studies are needed to determine

whether pregnancy per se is a risk factor that

warrants routine influenza immunization. Pregnant

women should be immunized in their third

trimester if they are expected to deliver during

influenza season, as they will become household

contacts of their newborn (children < 6 months

of age are at increased risk of complications from influenza).

Breast-feeding mothers: Influenza immunization

does not adversely affect the health of

breast-feeding mothers or their infants.

Breast-feeding is not a contraindication for influenza

immunization.

People at high risk of influenza complications

embarking on foreign travel to destinations

where influenza is likely to be circulating

should be vaccinated with the most current available

vaccine. In the tropics, influenza can occur

throughout the year. In the southern hemisphere,

peak activity occurs from April through

September. In the northern hemisphere, peak activity

occurs from November through March.

Employers and their employees should consider

yearly influenza immunization for healthy

working adults as this has been shown to decrease

work absenteeism because of respiratory and

other illnesses.

Concern has been raised regarding the possibility

that a pandemic influenza strain may emerge

through human-avian gene reassortment within

workers directly involved in poultry culling

operations, who may become simultaneously

infected with a human influenza virus strain and

an avian influenza virus strain. This is a

theoretical concern, given that this gene reassortment

has not been documented to date. FLUVIRAL®

protects against human but not avian influenza

strains. Immunization is recommended for those

directly involved in the destruction (culling) of

avian influenza-infected poultry before the

culling operation. Direct involvement may be

defined as sufficient contact with infected

poultry to allow transmission of avian virus to the

exposed person. The relevant individuals include

those performing the cull as well as others

(such as supervising veterinarians and

inspectors) who may be directly exposed to the avian

virus. Those persons who would be expected by

reason of their employment to come into direct

contact with infected poultry during culling

operations in the event of potential avian influenza

outbreaks should be immunized with trivalent

influenza vaccine on a yearly basis prior to the

human influenza season (CCDR, June 15, 2004).

CONTRAINDICATIONS

oKnown or suspected hypersensitivity to FLUVIRAL

® , to thimerosal, or to any other

ingredient in the formulation or component of the

container. For a complete listing, see

the DOSAGE FORMS, COMPOSITION AND PACKAGING section.

oVaccination is not recommended for subjects who

develop anaphylactic type reactions

when they eat eggs (urticaria (hives), oedema of

the mouth and throat, difficulty in

breathing, hypotension and shock). Allergic

reactions are extremely rare and usually

attributable to extreme sensitivity to certain

components of the vaccine, probably to

trace amounts of residual egg protein. Subjects

whose allergy to eggs is not of the

anaphylactic type, as well as those who are

allergic to chicken and to feathers may be

vaccinated.

oSubjects with an acute respiratory infection or

with any other active infection or serious

febrile illness. On the other hand, a minor

indisposition such as a mild infection of the

upper respiratory tract is not necessarily a contraindication to vaccination.

oImmunization should be delayed in a patient with

an active neurologic disorder, but

should be considered when the disease process has been stabilized.

WARNINGS AND PRECAUTIONS.

oSterile epinephrine hydrochloride solution

1:1000 should always be readily available in

case an acute anaphylactic reaction should occur.

General

Increase of serum theophylline to toxic levels

following the administration of influenza vaccine

has been recorded in individuals who take oral

theophylline as a maintenance therapy. Some

doctors recommended a cessation of theophylline

or a reduction in dose for 24 hours following

vaccination.

The administration of influenza vaccine may also

delay the hepatic metabolism of other

medications such as oral anticoagulants.

False-positive HIV antibody tests were reported

after immunization with the 1991/92 influenza

vaccines. However, the incidence of

false-positive tests declined with the development of

different tests so that such false-positive HIV

antibody tests are not likely to be a problem now.

Immune

It is possible that the protective immune

response following influenza vaccination may not

develop in subjects undergoing immunosuppressive therapy.

Corticosteroid therapy can result in

immunosupression although the exact dose and duration of

therapy required to suppress the immune system is

not well defined. Persons treated with high

doses of systemic steroids, e.g., =2 mg/kg/day of

prednisone orally for more than 2 weeks, or =

60 mg prednisone/day in an adult, should be

considered to have a compromised immune

system.

Local Skin Reactions at Vaccination Sites

Soreness and redness at the injection site may

occur and may last for up to two days.

Prophylactic acetaminophen may decrease the

frequency of pain at the injection site.

Respiratory

Revaccination of individuals who have previously

experienced oculo-respiratory symptoms is

safe. Previously affected individuals should be

encouraged to be revaccinated. The risk of

recurrence of oculo-respiratory symptoms after

revaccination is minimal compared to the

serious threat posed by influenza. Please refer

to most current NACI recommendations

regarding revaccination of subjects who

experienced more severe oculo-respiratory syndrome

(see references).

Special Populations

Pregnant Women: The National Advisory Council on

Immunization considers influenza

vaccine safe in pregnancy.

Pediatrics: In infants < 6 months of age,

influenza vaccine is less immunogenic than in infants

and children aged 6 to 18 months. Therefore,

immunization with currently available influenza

vaccine is not recommended for infants < 6 months.

ADVERSE REACTIONS

Adverse Drug Reaction Overview

Subvirion, or split-virion, vaccines contain

purified portions of the virus rather than the entire

virus. Generally, these have been shown to be

associated with fewer adverse effects in children

and young adults, while maintaining

immunogenicity similar to that of whole virus

preparations. Because of their lower rates of

side effects, only split virus preparations are

recommended for children under 13 years of age.

Immediate, allergic-type responses, such as

hives, angioedema, allergic asthma, or systemic

anaphylaxis occur extremely rarely. These

reactions probably result from sensitivity to some

vaccine component - most likely residual egg proteins (see CONTRAINDICATIONS).

The most common FLUVIRAL® adverse drug reactions

are soreness at the injection site,

headache and muscle aches. Reactions are

generally mild and of limited duration. Prophylactic

acetaminophen may decrease the frequency of some side effects in adults.

Clinical Trial Adverse Drug Reactions

Because clinical trials are conducted under very

specific conditions the adverse reaction rates

observed in the clinical trials may not reflect

the rates observed in practice and should not be

compared to the rates in the clinical trials of

another drug. Adverse drug reaction information

from clinical trials is useful for identifying

drug-related adverse events and for approximating

rates.

The data in the table below have been derived

from three studies with three lots of ID

Biomedical split-virion vaccine (A, B, C)

compared to another subvirion vaccine (D) and to a

whole virion vaccine (E) from ID Biomedical.

Local and systemic reactions are reported after

vaccination with a split-virion influenza vaccine.

There were very few reports of fever as defined by temperature over 38°C.

Soreness at the injection site was the most

frequently reported symptom, and was generally

rated as mild and resolved the day after vaccination.

For systemic symptoms, headache and muscle aches

were the most common. As with local

symptoms, these were generally reported as mild and of limited duration.

Prophylactic acetaminophen may decrease the

frequency of some side effects in adults.

Post-Market Adverse Drug Reactions

In October 2000 the vaccine adverse event

surveillance system in Canada received reports of

individuals developing red eyes and respiratory

symptoms occurring shortly after influenza

vaccination. For surveillance purposes the public

health authorities defined a new influenza

vaccine associated syndrome, the so-called

Oculo-Respiratory Syndrome (ORS), and increased

surveillance for this was initiated by Health Canada.

The symptoms associated with the ORS are red

eyes, respiratory symptoms and facial oedema

Most cases are mild in severity and resolve

spontaneously regardless of the influenza vaccine

administered. According to Health Canada's

surveillance information, in the 2000-2001

immunization campaign, 260 cases of ocular and/or

respiratory symptoms were reported for

every million doses of FLUVIRAL® distributed, and

only 88 cases (approx.0.009%) presenting

both ocular and respiratory symptoms. Despite the

enhanced surveillance and increased public

awareness, the reported cases declined

significantly during the following years. In the 2002-

2003 season the number of cases of ocular and

respiratory symptoms decreased to 29 cases

(approx. 0.003%) for every million doses of FLUVIRAL® distributed.

ORS symptoms had been reported with other

influenza vaccines in the US and Europe prior to

the incident in Canada in 2000. The enhanced

surveillance by Health Canada in 2000-2003, the

observations from independent investigators and

ID Biomedical investigations confirmed that

ocular and respiratory symptoms could be

associated with any influenza vaccines.

Revaccination of subjects with history of ocular

or respiratory symptoms is also considered to

be safe regardless of the influenza vaccine used

for the initial vaccination or the revaccination.

There have been reports of other neurological

illnesses, including facial paralysis, encephalitis,

encephalopathy, demyelinating disease and

labyrinthitis, associated with other influenza

vaccines. Any relationship, other than temporal,

to the vaccine has not been established.

Unlike the 1976-77 swine influenza vaccine,

subsequent vaccines prepared from other virus

strains have not been clearly associated with an

increased frequency of Guillain-Barrésyndrome.

Influenza vaccine is not known to predispose to Reye's syndrome.

Notification of reactions

It is desirable that all unusual reactions,

arising from any vaccination whatsoever, or following

shortly thereafter, be reported to the

manufacturer of the product and to the provincial

epidemiologist.

Drug Interactions

Drug-Drug Interactions

The metabolism of oral theophylline or oral

anticoagulants may be affected by vaccination with

FLUVIRAL® (see WARNINGS AND PRECAUTIONS).

The target groups for influenza and pneumococcal

vaccination overlap considerably. Health

care providers should take the opportunity to

vaccinate eligible persons against pneumococcal

disease during the same visit at which influenza

vaccine is given. The concurrent

administration of the two vaccines at different

sites does not increase the risk of side effects.

Pneumococcal vaccine, however, is not

administered annually, as in the case of influenza

vaccine.

Children at high risk may receive influenza

vaccine at the same time but at a different site from

that used for routine pediatric vaccines.

DOSAGE AND ADMINISTRATION

Recommended Dose and Dosage Adjustment

Influenza vaccine dosage, by age group

Age Group Dosage Route †

6 - 35 months 1 x 0.25 mL or 2 x 0.25 mL* IM

3 - 8 years 1 x 0.50 mL or 2 x 0.50 mL* IM

9 years and older 1 x 0.50 mL IM † The

recommended site of vaccination is the deltoid

muscle for adults and older children. The preferred site for

infants and young children is the anterolateral aspect of the thigh.

*Two doses administered at least one month apart

are recommended for children younger than 9 years of age

receiving influenza vaccine for the first time.

Since the likelihood of febrile convulsions is

greater in children aged 6 to 35 months, special

care should be taken in weighing relative risks and benefits in this group.

CAFV08/PI 8.11 approved Check the expiry date of

the vaccine carefully. Any vaccine beyond its expiry date should

not be used.

Administration

FLUVIRAL® vaccine must not be administered intravenously.

Shake the multidose vial vigorously each time

before withdrawing a dose of vaccine.

Proper aseptic technique should be used for

withdrawal of each dose from the multidose vial.

Once entered, return the multidose vial to the

recommended storage conditions, between 2°C

and 8°C. Once entered, the multidose vial should be discarded after 28 days.

A separate sterile syringe and needle or a

sterile disposable unit should be used for each

injection to prevent transmission of hepatitis B,

HIV, or other infectious agents from one person

to another.

Disinfect the skin at the site of injection with

a suitable antiseptic and wipe dry with sterile

cotton wool. The injection of FLUVIRAL ® should

be given intramuscularly, usually into the

deltoid muscle. Do not inject influenza vaccine intravenously.

All vaccinees should be observed for about 15

minutes after vaccination. If an anaphylactic

reaction develops, sterile epinephrine

hydrochloride (1:1000) should be administered.

OVERDOSAGE

In a study by Matzkin and Nili (1984), following

administration of a dose of flu vaccine 10

times greater than the recommended dose of 0.5

mL, adverse events were not significantly

different between study and control subjects.

There have been reports of patients who received

higher than recommended doses of

FLUVIRAL®. The adverse events noted in these

patients were similar to those reported from

patients who had received the recommended dose.

ACTION AND CLINICAL PHARMACOLOGY

Mechanism of Action

FLUVIRAL ® , split-virion inactivated influenza

vaccine, promotes an active immunization

against influenza strains A (H1N1 and H3N2) and

B. Within seven days after injection of the

vaccine there is an increase in circulating

antibody to the viral haemagglutinin and peripheral

blood lymphocytes are primed to respond to in

vitro stimulation by vaccine antigens. As with

other inactivated influenza vaccines,

immunization is based on the humoral component of the

specific immunological defense system, namely

immunoglobulin G (IgG) antibodies against

viral hemagglutinin (HA) and neuraminidase

antigens. The effectiveness of inactivated

influenza vaccines correlates with the age and

immunocompetence of the vaccine recipient and

the degree of similarity between the virus

strains used in the preparation of the vaccines and

those prevailing in the population.

Cytotoxic T lymphocyte response occurs after

administrations of either killed or live virus

vaccines and is detectable in the absence of demonstrable antibody response.

Pharmacodynamics/Pharmacokinetics

No pharmacodynamics studies and no

pharmacokinetics studies have been conducted with

FLUVIRAL ® in accordance with its status as a vaccine.

Duration of Effect

Both humoral and cell-mediated responses are

thought to play a role in immunity to influenza.

Immunity declines over the year following

vaccination. The production and persistence of

antibody after vaccination depends on numerous

factors, including age, prior and subsequent

exposure to antigens, presence of

immunodeficiency states, and polymorphisms in HLA class II

molecules. Humoral antibody levels, which

correlate with vaccine protection, are generally

achieved by 2 weeks after immunization. It is

postulated that immunity after administration of

the inactivated vaccine lasts < 1 year. However,

in the elderly, antibody levels may fall below

protective levels within 4 months. Data are not

available to support a recommendation for the

administration of a second dose of influenza

vaccine in elderly individuals in order to boost

immunity. (CCDR, June 15, 2004)

STORAGE AND STABILITY

FLUVIRAL ® must be stored between 2°C and 8°C.

Do not freeze. Freezing destroys activity. Do not

use vaccine that has been frozen.

Do not use vaccine after expiration date.

Once entered, the multidose vial should be discarded after 28 days.

SPECIAL HANDLING INSTRUCTIONS

The vaccine should be well shaken prior to use (see DOSAGE AND ADMINISTRATION

section).

FLUVIRAL ® and materials used during vaccination

should be disposed of in the same way as

other drugs administered by injection. Since

split-virion influenza vaccine is an inactivated

vaccine, it presents no risk of contaminating the

work area during manipulation.

DOSAGE FORMS, COMPOSITION AND PACKAGING

The composition of FLUVIRAL ® is established in

agreement with the recommendations of the

Canadian National Advisory Committee on

Immunization (NACI) and the World Health

Organization (WHO).

For the 2005-2006 season, each dose of 0.5 mL of

the split-virion influenza vaccine contains:

15 µg haemagglutinin of Strain A/New Caledonia/20/99 (H1N1),

15 µg haemagglutinin of Strain A/New York/55/2004 (H3N2),

15 µg haemagglutinin of Strain B/Jiangsu/10/2003.

The vaccine also contains 0.01% thimerosal as a

preservative, and trace residual amounts of egg

proteins and sodium deoxycholate. Antibiotics are

not used in the manufacture of this vaccine.

FLUVIRAL ® is supplied in 5 mL vials holding 10 x

0.5 mL doses. Also available in 0.5 mL

unidose syringes.

REFERENCES

1. National Advisory Committee on Immunization

(NACI): Statement on Influenza Vaccination

for the 2005-2006 Season. Canada Communicable

Disease Report, http://www.phac-aspc.

gc.ca/publicat/ccdr-rmtc. To be published in 2005.

ID Biomedical Corporation

2323, Parc Technologique Blvd.

Quebec City, QC

Canada G1P 4R8