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

项目摘要/摘要 尽管全球仍有相当数量的麻疹疫苗，但麻疹疫苗接种已有数十年的历史。 病例和死亡仍在继续。实现消除麻疹目标的战略需要更全面的 在整个过程中对跨越空间、时间和年龄的免疫力和负担模式的理解 世界，特别是在低收入和中等收入国家。这些挑战在一定程度上可以通过 彻底检查关于麻疹免疫、病例和死亡的所有可用数据，并综合这些数据 通过开发新的数学和统计模型产生数据流，特别是在 国家以下级别。这项提议将首先通过系统地搜索全球麻疹免疫模式来量化全球麻疹免疫模式 所有可用的血清阳性率研究和催化建模，以描述按地点和年龄的模式。接下来，我们 将使用病例通知估计六个负担最重的国家的次国家麻疹发病率， 血清学数据和国家以下地区疫苗覆盖率估计。然后，评估当地麻疹最高的地区 死亡率，我们将使用所有可用的文献和空间可用来估计国家以下病例的死亡率 协变量。最后，我们将评估次国家目标免疫的经济和健康效益。 战略而不是以国家为基础的方法。 该项目将在国家和国家以下各级调查全球麻疹免疫和死亡模式， 以及评估各种疫苗接种战略的国家以下目标的成本效益。目标是 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，以便制定计划 知情的免疫工作以及麻疹控制和消除方案。在完成后 这项研究和培训奖学金，申请者将获得高级技能在时空和 统计建模、传染病和疫苗接种流行病学、经济评估、科学 沟通，课堂教学。申请者寻求这些领域的专业知识，以便在 努力消除和控制麻疹，并提高对国家以下各级的作用的总体认识 在优化疾病控制和地方卫生倡议方面的分析和估计。一个多学科的和 协作团队将指导和指导申请者进行研究和培训，并协助准备 申请在传染病、疫苗流行病学和数学建模方面的学术生涯， 重点是进行及时的、与政策相关的研究。

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.