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Priorities in the Measles and Rubella Research Agenda. William Moss, MD, MPH Johns Hopkins Bloomberg School of Public Health. 11 th Annual Meeting of The Measles and Rubella Initiative September 18, 2012. Global Measles and Rubella Strategic Plan

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priorities in the measles and rubella research agenda

Priorities in the Measles and Rubella Research Agenda

William Moss, MD, MPH

Johns Hopkins Bloomberg School of Public Health

11th Annual Meeting of The Measles and Rubella Initiative

September 18, 2012

slide2
Global Measles and Rubella Strategic Plan
  • High population immunity and vaccine coverage
  • Effective surveillance, monitoring evaluation
  • Outbreak preparedness and response
  • Public confidence and demand for immunization
  • Research and development
developing a research agenda
Developing a Research Agenda

Clear and explicit program goals

Specified target audience

Answerable research questions

Strategies to address research questions

Milestones and review of progress

Flexibility in adapting research agenda

measles landscape analysis for the bill and melinda gates foundation december 2008
Measles Landscape Analysis for the Bill and Melinda Gates FoundationDecember 2008
  • Effect of measles activities on health systems
  • Improve monitoring by:
      • developing field-friendly laboratory assays to validate coverage
      • developing immunization (and child-health) registries
  • Improve surveillance by obtaining:
      • data on measles age-specific sero-prevalence
      • baseline data on rubella
  • Commission a MCV market supply study
public health questions to which modelling can have a major contribution
Public health questions to which modelling can have a major contribution

Improve existing modelling methods to estimate mortality

Assess the burden of CRS

Optimize strategies for measles and rubella control

birth rate

population density

rural-urban migration

seasonality of infection

contact patterns

Potential impact of waning immunity

Cost-effectiveness of different goals and strategies

Measles Landscape Analysis

global measles and rubella research meeting may 2011
Global Measles and Rubella Research MeetingMay 2011

Organizational structure

Measles epidemiology

Vaccine Development and Effectiveness, Alternative Delivery Methods and Laboratory Methods

Immunization Strategies

Mathematical Modeling and Economic Analyses

Rubella Control and Elimination

Key research questions distilled from 137 questions

working group members
Working Group Members

Measles Epidemiology

Lead author: James Goodson

Other members of working group: Abhijeet Anand, Nino Khetsuriani, William Moss, David Sniadack

Vaccine Development and Effectiveness, Alternative Delivery Methods and Laboratory Methods Research Agenda

Lead authors: Paul Rota, David Featherstone

Other members of working group: William Bellini, Ana-Maria Henao-Restrepo, Robert Keegan, Sara Lowther, Claude Muller.

Immunization Strategies Research Agenda

Lead authors: Peter Strebel, Rebecca Martin, Lisa Cairns

Other members of working group: Steve Cochi, Vance Dietz, Alan Hinman, Edward Hoekstra, Eric Mast, Linda Quick, Maya Van Den Ent, Margie Watkins

Mathematical Modeling and Economic Analyses Research Agenda

Lead authors: Kim Thompson, Maya Vijayaraghavan

Other members of work group: Walt Dowdle, Matthew Ferrari, Manoj Gambhir, Chris Gregory, Katrina Kretsinger, Kathleen Wannemuehler

Rubella Research Agenda

Lead author: Susan Reef

Other members of work group: Emilia Vynnycky, Joseph Icenogle, Leo Weakland, Robert Linkins, Louis Cooper

measles epidemiology
Measles Epidemiology

Epidemiologic characteristics of measles in India

Causes of outbreaks in high coverage settings

Age infants lose protection from maternal antibodies

Implications of administering MCV1 prior to 9 months

Susceptibility and transmission among adults

Susceptibility among HIV-infected adults

vaccine development and effectiveness and alternative vaccine delivery methods
Vaccine Development and Effectiveness, and Alternative Vaccine Delivery Methods

Vaccine effectiveness in densely-populated settings

Improved vaccines:

thermo-stable

vial temperature monitors

self-reconstituting vials

alternative delivery methods

surveillance and laboratory methods
Surveillance and Laboratory Methods

Global distribution of measles virus genotypes

Rapid diagnostic tests for measles and rubella

High-throughput assays for neutralizing antibodies

Higher resolution for virologic surveillance

Differentiate wild-type and vaccine immunity

immunization strategies
Immunization Strategies

Increase uptake of routine 1st and 2nd doses

Maximize SIA coverage

Monitoring vaccination coverage (RI and SIA)

Vaccinating difficult to reach populations

Misconceptions and attitudinal barriers

Increase demand for vaccination

Outbreak response immunization activities

mathematical modeling and economic analyses
Mathematical Modeling and Economic Analyses

Modeling progress toward measles eradication

Threshold population size and susceptible density required to sustain measles virus transmission

Economic burden of measles outbreaks and response in low and middle income countries

rubella control and elimination
Rubella Control and Elimination

Birth rates and the epidemiology of rubella and CRS

Methods and costs for identifying CRS cases

Refusal and acceptance of MMR vaccine

Global distribution of rubella virus genotypes

Economic burden of rubella and CRS

research questions from measles management meeting
Research Questions from Measles Management Meeting

Americas

Identification of high risk groups

Transmission in settings of high vaccine coverage

Europe

Role of adolescents and adults

Waning immunity

Economic analyses and disease burden modeling

Burden of rubella and CRS

Communication strategies

Western Pacific

Transmission among infants, adolescents and adults

Outbreak response: triggers, threshold and scope

sage working group on measles and rubella
SAGE Working Group

on Measles and Rubella

terms of reference
Terms of Reference

Identify gaps in essential evidence and programme barriers to achieving measles and rubella/CRS elimination targets and present SAGE with proposed areas for operational or basic science research.

approach
Approach
  • Define the context for research priority setting
  • Identify research questions and knowledge gaps
  • Define criteria for research priority setting
  • Score listed research questions using criteria
  • Address stakeholder values
  • Refine questions and implementation process
  • Periodic re-evaluation of research priorities
summary
Summary

Many key research questions have been identified

Next steps

Consensus on highest priority research questions to advance strategic plan

Develop strategies to address these questions

Identify milestones and targets

Assess progress

Adapt research agenda to changing need

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