Development and application of subnational measles incidence and mortality estimates in high burden and incidence settings

项目概要/摘要 麻疹疫苗已经有几十年的历史了，尽管全球仍有相当数量的人接种麻疹疫苗。 病例和死亡持续存在。实现消除麻疹目标的战略需要更全面的 了解各地不同空间、时间和年龄的免疫和负担模式 世界，特别是低收入和中等收入国家。这些挑战部分可以通过 彻底检查所有关于麻疹免疫、病例和死亡的现有数据，并综合这些数据 数据流，通过开发新的数学和统计模型，特别是 国家以下各级。该提案将首先通过系统搜索全球麻疹免疫模式， 所有可用的血清阳性率研究和催化模型，以描述按地点和年龄划分的模式。接下来我们 将利用病例通报来估计六个负担最重国家的国家以下各级麻疹发病率， 血清学数据和国家以下各级疫苗覆盖率估计数。然后，评估麻疹发病率最高的地方， 死亡率，我们将使用所有可用的文献和可用的空间来估计国家以下一级的病死率 协变量最后，我们将评估国家以下各级有针对性的免疫接种的经济和健康效益 以国家为基础的战略。 该项目将调查国家和国家以下各级的全球麻疹免疫和死亡模式， 以及评估国家以下各级针对各种疫苗接种战略的成本效益。目标 这项研究的目的是为全球利益相关者和当地决策者提供经验证据， 知情的免疫接种工作以及麻疹控制和消除方案。完成后 这项研究和培训奖学金，申请人将获得先进的技能，在时空和 统计建模，传染病和疫苗接种流行病学，经济评估，科学 沟通和课堂教学。申请人寻求这些领域的专门知识，以促进 消除和控制麻疹的努力，并提高对国家以下各级 在优化疾病控制和地方卫生举措方面的分析和估计。多学科和 合作团队将指导和指导申请人的研究和培训，并协助准备 申请人的学术生涯在传染病和疫苗流行病学和数学建模， 重点是及时进行与政策有关的研究。

Project Summary/Abstract Vaccination against measles has been available for decades, although still a substantial number of global cases and deaths persist. Strategies to reach measles elimination goals require a more comprehensive understanding of the patterns of immunity and burden across space, time and age in local contexts throughout the world, particularly in low- and middle-income countries. These challenges, in part, can be addressed via a thorough examination of all available data on measles immunity, cases, and deaths and synthesizing these data streams through the development of novel mathematical and statistical models, particularly on subnational scales. This proposal will first quantify global measles immunity patterns via a systematic search of all available seroprevalence studies and catalytic modeling to describe patterns by location and age. Next, we will estimate subnational measles incidence in the six highest burden countries using case notifications, serology data, and subnational vaccine coverage estimates. Then, to assess local areas with highest measles mortality, we will estimate subnational case-fatality using all available literature and spatially available covariates. Finally, we will assess the economic and health benefits of subnationally-targeted immunization strategies over a nationally based approach. This project will investigate global measles immunity and mortality patterns at national and subnational scales, as well as evaluate the cost-effectiveness of subnational targeting of various vaccination strategies. The goal of this research is to provide empirical evidence for global stakeholders and local decision makers to plan informed immunization efforts as well as measles control and elimination programing. After the completion of this research and training fellowship, the applicant will have acquired advanced skills in spatiotemporal and statistical modeling, infectious disease and vaccination epidemiology, economic evaluation, scientific communication, and classroom teaching. The applicant seeks expertise in these fields in order to advance measles eradication and control efforts and to improve the overall understanding the role of subnational analyses and estimates in optimizing disease control and local health initiatives. A multidisciplinary and collaborative team will mentor and guide the applicant in research and training and assist in preparing the applicant for an academic career in infectious disease and vaccine epidemiology and mathematical modeling, with a focus on producing timely and policy-relevant research.