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

项目概要/摘要 麻疹疫苗接种已有数十年历史，但全球仍有大量疫苗接种 病例和死亡持续存在。实现消除麻疹目标的策略需要更全面的 了解当地环境中跨空间、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。这些挑战可以部分地通过以下方式解决： 彻底检查有关麻疹免疫力、病例和死亡的所有可用数据并综合这些数据 通过开发新颖的数学和统计模型，特别是在 地方层面。该提案将首先通过系统搜索来量化全球麻疹免疫模式 所有可用的血清流行率研究和催化模型，以按地点和年龄描述模式。接下来，我们 将利用病例通知估计六个负担最重的国家的地方麻疹发病率， 血清学数据和地方疫苗覆盖率估计。然后，评估麻疹发病率最高的地区 死亡率，我们将利用所有现有文献和可用空间来估计地方病死率 协变量。最后，我们将评估地方性定向免疫接种的经济和健康效益 战略优于基于国家的方法。 该项目将调查国家和次国家范围内的全球麻疹免疫力和死亡率模式， 以及评估国家以下各级针对各种疫苗接种策略的成本效益。目标 这项研究的目的是为全球利益相关者和当地决策者制定计划提供经验证据 知情的免疫工作以及麻疹控制和消除规划。完成后 通过这项研究和培训奖学金，申请人将获得时空和领域的高级技能 统计模型、传染病和疫苗接种流行病学、经济评估、科学 沟通、课堂教学。申请人寻求这些领域的专业知识以推进 消除和控制麻疹的努力，并提高对国家以下各级的作用的总体了解 分析和估计优化疾病控制和地方卫生举措。一个多学科和 合作团队将指导和指导申请人进行研究和培训，并协助准备 传染病和疫苗流行病学和数学建模学术职业的申请人， 重点是及时开展与政策相关的研究。

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.